General Surgery

Cherenko Makar Petrovych. To the 100th anniversary of his birth

L.Y. Markulan — 2025-10-30

The biographical essay is dedicated to the outstanding Ukrainian surgeon, one of the founders of thyroid surgery in Ukraine, Honored Worker of Science and Technology, laureate of the State Prize of Ukraine in Science and Technology, Professor Makar Petrovych Cherenko – whose life and work became a model of devotion, humanism, and exceptional professional mastery. The essay presents the key milestones of his biography, scientific achievements, pedagogical and public activity, as well as his contribution to the formation of the Ukrainian surgical school.

The shape and volume restoration of the mammary glands in postoperative deformations

M. V. Lashchenko — 2025-10-30

This article is dedicated to modern methods of reconstructive and plastic breast surgery in women with postoperative deformities. Reconstruction of the mammary glands in cases of postoperative deformities relies on a variety of surgical techniques. The selection of an appropriate method depends on the morphological characteristics of the defect, tissue condition, prior surgical history, and the patient’s overall somatic status. The article highlights the anatomical and aesthetic parameters of the mammary glands, the classification of postoperative deformities, and modern approaches to secondary reconstruction (implants, autologous tissues, lipofilling), the importance of preserving or restoring the nippleareolar complex, as well as methods for objective measurement of breast shape and volume, including 3D scanning, magnetic resonance imaging (MRI), and mathematical models. The main approaches to reconstruction are discussed: implants, tissue expanders, autologous flaps (DIEP, TRAM, TDAP, SGAP, LICAP), and lipofilling as an additional or independent option for minor defects. Their advantages, disadvantages, and indications are analyzed. Special attention is given to breast symmetry, the influence of individual anatomical features of the patient, and the staging of surgical interventions. It is emphasized that early reconstruction after mastectomy contributes to better psychological rehabilitation, and the restoration of the breast’s aesthetic units improves patients’ quality of life. MRI is identified as the most accurate method for assessing breast volume, although less invasive and more accessible methods are preferred in routine practice. The article summarizes current approaches to the planning and execution of secondary reconstructive surgery for restoring breast shape, volume, and symmetry. The importance of an individualized approach is emphasized to achieve optimal aesthetic and functional outcomes.

Clinical case of surgical treatment of undifferentiated pleomorphic liver sarcoma

Y. P. Bakunets — 2025-10-30

Undifferentiated pleomorphic liver sarcoma (UPS), formerly known as malignant fibrous histiocytoma (MFH), represents a very rare primary hepatic tumour. It was first described by O’Brien and Stout in 1964. This type of tumour is the most prevalent malignant soft tissue tumour, which usually occurs in adulthood and affects the extremities, less commonly the retroperitoneum and abdominal organs.

Objective – to present the treatment outcomes of a rare case of UPS of the liver. The article describes a clinical case of surgical treatment of a patient with UPS of the liver. Patient N., 36 years old, complained of pain in the right hypochondrium, fever, and general weakness. According to the results of instrumental examinations, the clinical diagnosis was made: primary liver tumour, tumour rupture, and intra‑abdominal bleeding. After preoperative preparation, a right‑sided hemihepatectomy, D2 lymphadenectomy, cholecystectomy, and abdominal drainage were performed. The histopathological and immunohistochemical features of the tumour cells were most consistent with undifferentiated pleomorphic liver sarcoma. According to the Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC) sarcoma grading system, a total score of 7 (G3) was assigned. The diagnosis was undifferentiated pleomorphic liver sarcoma, pT_4aN₀M₀ G3 stage III, grade 2. Six months later, a CT scan of the abdominal cavity revealed a tumour focus in the right subdiaphragmatic space with invasion of the right diaphragm dome, liver segment IV, and right kidney.

Surgical intervention was performed in volume: viscerolysis, atypical resection of the SgIV liver with right‑sided nephrectomy and resection of the right dome of the diaphragm, aortocaval lymphadissection. Postoperative diagnosis: undifferentiated pleomorphic liver sarcoma rpT₄N_1(1/2)M₀ G3, R0, stage III, grade 2. Currently, the period of recurrence‑free observation is 12 months after the second surgery.

Differentiated approach to treatment of severe acute pancreatitis based on organ failure pattern

H. O. Levytskyi — 2025-10-30

Severe acute pancreatitis (SAP) complicated by organ failure (OF) is associated with mortality rates of 15 – 40%. While the step‑up approach has proven superior to primary necrosectomy, its universal application fails to account for the heterogeneity of clinical trajectories. Early stratification of patients based on OF patterns may facilitate the development of personalised treatment protocols.

Objective – to evaluate the effectiveness of a differentiated treatment approach to severe acute pancreatitis based on organ failure patterns in comparison to standard disease management.

Materials and methods. A quasi‑experimental study with historical control was conducted in 77 patients with SAP or high risk of its development. The comparison group (n=41, 2014 – 2019) received standard treatment with retrospectively confirmed OF development. The main group (n=36, 2022 – 2024) underwent prospective stratification using a prognostic model within 24 hours of admission, identifying three OF patterns: early respiratory‑renal, late respiratory, and early multisystem. Pattern‑specific protocols were applied: aggressive early drainage for the early respiratory‑renal pattern, a maximal conservative approach for the late respiratory pattern, and intensive monitoring with readiness for emergency interventions for the early multisystem pattern. The primary endpoint was hospital length of stay (LOS). Secondary endpoints included OF development, intensive care unit (ICU) utilisation, surgical interventions, and mortality.

Results. Median hospital LOS decreased from 35 [23 – 65] to 27 [15 – 33.25] days (p=0.015), representing a 22.9% reduction. OF development was prevented in 33.3% of high‑risk patients (the number needed to treat is 3). The incidence of persistent OF decreased from 90.2% to 50.0% (odds ratio (OR)=0.11, 95% confidence interval (CI): 0.03 – 0.37, p<0.0001), and multiorgan failure from 31.7% to 5.6% (p=0.004). The treatment effect was pattern‑dependent (interaction p<0.0001): the late respiratory pattern showed a 44.4% LOS reduction (61.1±27.2 to 34.0±23.6 days, p=0.005), the early multisystem pattern demonstrated a 47.2% reduction (50.2±32.8 to 26.5±19.3 days, p=0.042), while the early respiratory‑renal pattern showed a non‑significant increase (+31.3%, p=0.870). The proportion of staged open operations decreased from 58.5% to 22.2% (p=0.001) without affecting emergency surgery rates. Mortality decreased from 12.2% to 8.3% (p=0.579).

Conclusions. Pattern‑oriented treatment of SAP significantly reduces hospitalisation duration and prevents OF development in one‑third of high‑risk patients. Treatment efficacy is heterogeneous across patterns, with the greatest benefit observed in late respiratory and early multisystem variants. This approach transforms the surgical paradigm from reactive to proactive, optimising intervention timing based on predicted clinical trajectory. Further multicentre validation is warranted to confirm these findings.

Bipolar vaporization of hemorrhoidal nodes in stage III chronic hemorrhoids: a single-centre comparative study involving laser hemorrhoidoplasty, transanal dearterialization, and Longo surgery

L. S. Bilianskyi — 2025-10-30

Objective – to compare the effectiveness and safety of bipolar vaporization (BPV) of hemorrhoidal nodes with laser hemorrhoidoplasty (LHP), transanal dearterialization (THD), and stapled hemorrhoidopexy (Longo surgery) in patients diagnosed with stage III chronic hemorrhoids.

Materials and methods. A single‑centre, prospective, comparative study was conducted involving 63 patients (35 women and 28 men) with symptomatic stage III chronic hemorrhoids treated between 2021 and 2024. The mean age was 45.3±11.1 years, the mean body mass index was 26.8 kg/m², and the mean disease duration was 10.3±6.7 years. Patients were allocated to four groups based on the treatment method: BPV (n=18, 28.6%), LHP (n=15, 23.8%), THD (n=16, 25.4%), and Longo surgery (n=14, 22.2%). Bipolar vaporization was performed according to the author’s method using the biowelding generator EK‑300M (Svarmed, Ukraine) with multi‑cycle vaporization of the node. Outcomes assessed included symptoms, complications, recurrences, patient satisfaction, duration of surgery, and length of hospital stay.

Results. The mean duration of surgery was 45.2±6.3 minutes in the BPV group, 44.5±7.5 minutes in the LHP group, 43.4±6.2 minutes in the THD group, and 41.1±4.9 minutes in the Longo surgery group (p>0.05). Blood loss ranged from 10.4 to 16.4 ml across all groups (p>0.05). The incidence of submucosal hematomas did not exceed 35% in any group. All techniques resulted in a significant reduction in hemorrhoid symptoms postoperatively (p<0.05 within groups). At one year post‑surgery, recurrence rates were 5.6% for BPV, 6.7% for LHP, 18.8% for THD, and 21.4% for Longo surgery (p=0.422). Patient satisfaction scores at 12 months ranged from 7.7 to 8.1 points.

Conclusions. Bipolar vaporization demonstrates effectiveness comparable to other minimally invasive techniques for the treatment of grade III chronic hemorrhoids, with minimal trauma and a short postoperative recovery period. The method is cost‑effective due to the use of reusable electrodes. Bipolar vaporization is recommended for broader adoption in proctological practice, particularly in resource‑limited settings.

Association between rs571312 MC4R and rs3810291 TMEM160 single-nucleotide polymorphisms and metabolic surgery outcomes

P. A. Kobzar — 2025-10-30

Objective – to determine the association between the SNP rs571312 MC4R and SNP rs3810291 TMEM160 genes and the results of metabolic surgery.

Materials and methods. A prospective, observational, monocentric cohort study was conducted at the Department of General Surgery No2 of Bogomolets National Medical University. A total of 112 patients with surgical indications were offered bariatric surgery. Patients who agreed to undergo bariatric surgery (n=53) comprised the main group. Those who refused surgical treatment (n=59) formed the control group. The main group underwent bariatric interventions, including laparoscopic gastric bypass and laparoscopic sleeve gastrectomy, whereas patients with BMI ≥50 kg/m2 had a twostage surgical treatment involving intragastric balloon placement for a period of 6 months, followed by gastric bypass within 14 days after balloon removal. The results for both groups were evaluated one year after the start of treatment. In the control group, 59 patients suffering from obesity received conservative treatment. Before the start of treatment, all patients underwent anthropometric examinations and analysis of buccal epithelial scrapings. Genetic studies included DNA collection and isolation, as well as genotyping to determine polymorphisms of the rs571312 MC4R and rs3810291 TMEM160 genes.

Results. A strong correlation was found between bariatric surgery outcomes and the presence of rs571312 MC4R and rs3810291 TMEM160 gene polymorphisms in the study group (r=0.622; p≥0.001). There was no significant association between the degree of gene dominance and bariatric surgery outcomes (r=0.112, p≥0.5).

Conclusions. In the studied cohort, a relationship was found between the effectiveness of bariatric procedures and the presence of the rs571312 MC4R (r=0.465) and rs3810291 TMEM160 (r=0.55) polymorphisms, as well as the concurrent presence of both polymorphisms (r=0.622). The detection of these polymorphisms is associated with bariatric surgery outcomes, regardless of the degree of their genetic dominance (r=0.467).

Palliative laparoscopic hepaticojejunostomy: a single-centre prospective series

O. V. Ivanko — 2025-10-30

Objective – to assess the safety and efficacy of palliative laparoscopic hepaticojejunostomy in the management of distal bile duct obstruction.

Materials and methods. This single‑centre prospective cohort study included 22 patients with inoperable tumour‑related distal bile duct obstruction. Most participants were men (n=17 (77.3%)) with a mean age of 66.7±9.6 years. Bile duct obstruction was caused by pancreatic head adenocarcinoma (n=18), Vater’s papilla adenocarcinoma (n=2), cholangiocarcinoma (n=1), and duodenal melanoma (n=1). A total of 13 (59%) patients had a history of percutaneous transhepatic cholangiostomy, and 3 (13.6%) had unsuccessful endobiliary stenting attempts. All patients underwent palliative laparoscopic procedures, including Roux‑en‑Y hepaticojejunostomy (side‑to‑side or end‑to‑side) and entero‑enteric anastomosis. The primary endpoint was biliodigestive anastomosis patency without reintervention until death or end of observation. Secondary endpoints included 30‑day mortality, complications classified according to the Clavien–Dindo system, bile leakage defined by the International Study Group of Liver Surgery (ISGLS), length of hospitalization, time to resumption of enteral nutrition, and overall survival.

Results. The average duration of the operation was 354.5±110.1 minutes with an average blood loss of 58.3±43.1 ml. Complications occurred in 8 (37.5%) patients, including bile leakage in 7 cases (ISGLS B – in 6, ISGLS C – in 1 with biliary peritonitis), and one Clavien–Dindo IIIb event (torsion of the small intestine around the entero‑enteric anastomosis). No cases of wound infection or postoperative bleeding were recorded. The average length of hospitalization was 10.3±5.3 days (range, 4 – 24 days). Most patients (n=19 (86.3%)) were mobilized on the 1st postoperative day, and oral nutrition was initiated on the 2nd day. During the follow‑up period (median – 8.5 months, IQR 6.8 – 12.0), no recurrences of bile duct obstruction or need for repeated drainage were observed. Two episodes of acute cholangitis were managed conservatively. No deaths occurred within 30 days postoperatively.

Conclusions. Laparoscopic hepaticojejunostomy appears to be a feasible and effective palliative procedure for distal biliary obstruction in selected patients. This approach maintains anastomotic patency without the need for reintervention, is associated with low blood loss, and enables rapid resumption of enteral nutrition. The complication profile is primarily characterized by manageable bile leakage, with rare Clavien–Dindo grade IIIb adverse events. This method may be considered as an alternative to stenting when stenting is not possible or has failed, or in patients with a life expectancy >6 months who are scheduled for chemotherapy.

The role of minimally invasive diagnostic techniques in optimizing treatment strategies in patients with colorectal cancer

O. A. Danylenko — 2025-10-30

Objective – to improve staging accuracy and optimize therapeutic strategies in patients with colorectal cancer by performing minimally invasive diagnostic procedures, specifically diagnostic laparoscopy with peritoneal lavage and cytological examination, and mediastinoscopy with targeted lymph node biopsy, in cases where conventional imaging methods (computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography combined with computed tomography [PET‑CT]) yield equivocal or inconclusive results.

Materials and methods. This ambispective (retrospective–prospective) study was conducted from 2023 to 2025 and included 37 patients with colorectal cancer who had inconclusive standard imaging results regarding distant metastases or peritoneal carcinomatosis. Patients were allocated into two groups: 22 patients with suspected peritoneal carcinomatosis underwent diagnostic laparoscopy with peritoneal lavage, peritoneal biopsy, and cytological analysis, while 15 patients with suspected mediastinal lymph node involvement underwent cervical mediastinoscopy with targeted lymph node biopsy. Diagnostic accuracy, the impact of findings on subsequent therapeutic management, and procedural safety were evaluated.

Results. Peritoneal carcinomatosis was morphologically confirmed in 19 of 22 patients (86.4%), and metastatic involvement of mediastinal lymph nodes was confirmed in 11 of 15 patients (73.3%). Verification of the pathological process resulted in a change in therapeutic strategy for 29 of 37 patients (78.4%). Specifically, 27 patients (73.0%) received systemic chemotherapy, 7 patients (18.9%) underwent radical surgical procedures, 2 patients (5.4%) underwent palliative resection, and 1 patient (2.7%) declined further treatment. No serious intraoperative complications were observed. Minor postoperative events, including pain at the puncture site, subcutaneous emphysema, and transient fever, occurred in 8 patients (21.6%) and did not require additional treatment.

Conclusions. Incorporating diagnostic laparoscopy and mediastinoscopy into the colorectal cancer staging algorithm yields high diagnostic accuracy, supporting personalized treatment planning. The application of minimally invasive methods reduces unnecessary surgical interventions, shortens the time to initiation of systemic therapy, and may improve prognosis in patients with advanced disease.

Analysis of risk factors associated with complications after laparoscopic gastric bypass in patients with obesity

V. O. Nevmerzhytskyi — 2025-10-30

Global data indicate that complications after laparoscopic gastric bypass occur in 5.8 to 12.4% of patients. Recent studies identify prior abdominal surgeries, chronic liver diseases, arterial hypertension, chronic lung diseases, and repeated bariatric procedures as primary risk factors for postoperative complications.

Objective – to determine the primary risk factors associated with complications in obese patients after laparoscopic gastric bypass.

Materials and methods. A retrospective analysis was conducted on data from 556 obese patients, as defined by IFSO criteria, who underwent laparoscopic gastric bypass surgery between 2011 and 2025 at the Department of General Surgery No 2, Bogomolets National Medical University. Of these patients, 261 (46.3%) were men and 295 (53.7%) were women. The mean body weight was 151.88 (95% CI: 135.5 – 168.1) kg, and the mean body mass index was 46.73 (95% CI: 43.93 – 49.52) kg/m². The surgical and anesthetic risk, assessed using the ASA scale, was 3.42 (95% CI: 3.31 – 3.53). Two groups of patients were established: a control group (2011 – 2019) and an experimental group (2019 – 2024), to evaluate the impact of the new strategy on the incidence of complications.

Results. Univariate logistic regression analysis identified seven factors with a significance level of <0.1: duration of surgery, postoperative pain level, early mobilization, chronic obstructive pulmonary disease, gastroesophageal reflux disease, sleep apnea, and diabetes mellitus. To determine the minimum set of factorial features associated with the occurrence of complications in obese patients after laparoscopic gastric bypass, a multivariate logistic regression analysis was employed. This analysis identified five factorial features associated with complication risk: «duration of surgery», «postoperative pain level», «delayed mobilization», «sleep apnea syndrome», and «diabetes mellitus».

Conclusions. The factors influencing the development of postoperative complications in obese patients after laparoscopic gastric bypass surgery included the duration of surgery, postoperative pain level, delayed mobilization, sleep apnea syndrome, and diabetes mellitus.