General Surgery

Yosyp Hryhorovych Turovets – a life devoted to surgery

Y. P. Tsyura — 2026-03-31

This article reviews the life and professional achievements of Yosyp Hryhorovych Turovets (1899 –1987), an outstanding surgeon, scientist, and educator. It traces his path from a childhood in a peasant family in Volhynia to his professorship at the Kyiv Medical Institute. It highlights his academic training, clinical residency, and early medical practice, where his organisational skills became apparent. The article examines his wartime service in evacuation hospitals, participation in military campaigns, and research on gunshot wounds to blood vessels and joints. It notes his contributions to military field surgery, traumatology, reconstructive techniques, and the invention of a unique traumatological device. The article also discusses his post‑war scientific and teaching activities, departmental leadership, training of scientific personnel, implementation of innovative surgical methods, and production of educational films. It emphasises his role in introducing the term «herniology» and advancing hernia surgery. The article concludes by recognising Turovets’ significant impact on Ukrainian and global medicine, clinical science, and medical education.

Endoscopic transluminal interventions in the management of acute infected necrotizing pancreatitis. Literature review

N. V. Puzyr — 2026-03-31

Acute necrotizing pancreatitis remains one of the most challenging diseases in general surgery. Infection of necrotic tissue, sepsis, and organ failure are the main determinants of mortality in this pathology. Other life-threatening complications include intestinal obstruction, biliary obstruction, abdominal compartment syndrome, external fistulas, bleeding, and thrombosis of the splenic and portal veins. The formation of walled-off necrosis after the fourth week of disease creates anatomical conditions for a transluminal endoscopic access to the pathological focus when appropriate indications are present. Current management of acute necrotizing pancreatitis is based on a step-up minimally invasive strategy in which endoscopic interventions occupy a leading role. International clinical guidelines, particularly those of ESGE, AGA, and ASGE, support the endoscopic step-up approach as first-line therapy for infected walled-off necrosis. This strategy focuses on controlling septic manifestations rather than performing immediate necrosectomy. Key factors for success include appropriate timing of intervention, a multidisciplinary approach, and individualization of the treatment strategy. The optimal indications for escalation to more invasive procedures remain unresolved and are subject to ongoing debate, often depending on the experience of a particular specialized center. The complexity of clinical decision-making may also be related to differences in treatment approaches between general surgeons and endoscopists, which necessitates a balanced interdisciplinary collaboration.

This literature review highlights the main aspects of managing acute necrotizing pancreatitis with endoscopic transluminal interventions. A comprehensive understanding of the advantages and limitations of this technique promotes its further technical and tactical refinement to improve treatment outcomes.

Hepatorenal syndrome: historical perspectives on the recognition of the problem. Review

M. I. Tutchenko — 2026-03-31

Hepatorenal syndrome (HRS) is a severe functional complication of portal hypertension and liver cirrhosis, characterized by profound renal hemodynamic dysfunction in the absence of significant structural kidney damage and associated with high mortality. Recent studies report a 90‑day mortality of 40 – 60%, depending on disease severity and therapeutic interventions. The pathophysiology of HRS is primarily driven by marked splanchnic vasodilation, resulting in reduced effective arterial blood volume, renal vasoconstriction, and a decline in glomerular filtration rate. The association between advanced liver disease and renal dysfunction was first recognized in the 19th century, whereas a clear clinical definition of HRS emerged in the mid‑20th century. Subsequent advances led to the classification of HRS into two major types: type I, an acute, rapidly progressive form with a very poor prognosis, and type II, a more indolent form commonly associated with refractory ascites. Therapeutic strategies focus on restoring effective arterial circulation. The most evidence‑based pharmacological treatment is the combination of vasoconstrictors, particularly terlipressin, combined with albumin. Invasive approaches, including transjugular intrahepatic portosystemic shunt (TIPS), peritoneovenous shunting, albumin‑based extracorporeal liver support systems, and renal replacement therapy, are considered as supportive or bridging options in selected patients, especially those awaiting liver transplantation. Prevention of HRS is based on early infection control, avoidance of nephrotoxic agents, adequate correction of hypovolemia, and routine administration of albumin after large‑volume paracentesis. Overall, HRS represents a hallmark of advanced hepatic decompensation and requires early recognition and a multidisciplinary therapeutic approach.

Mechanism-oriented three-level classification of treatment methods for chronic hemorrhoidal disease. Review

L. Y. Markulan — 2026-03-31

Objective – to synthesize current approaches to the treatment of chronic hemorrhoids and to develop a mechanism-oriented classification of treatment methods that integrates the pathophysiological mechanism of action of interventions, the anatomical target of treatment, the degree of surgical invasiveness, and the organ-preserving potential of the procedures.

A comprehensive analysis of current literature on the pathogenesis of hemorrhoidal disease and its treatment modalities was conducted. The principal pathophysiological mechanisms underlying the disease, major therapeutic strategies for their correction, and corresponding clinical intervention technologies were systematized. Based on a conceptual analysis, a model of the interrelationships between pathogenic mechanisms, therapeutic strategies, and clinical treatment methods was constructed, forming the foundation for the proposed classification system. A mechanism-oriented classification of treatment methods for hemorrhoidal disease was developed, integrating pathophysiological mechanisms, therapeutic strategies for their correction, and clinical intervention technologies within a unified conceptual framework. The main therapeutic strategies identified include symptom control, induction of fibrosis of hemorrhoidal cushions, reduction of arterial inflow, intratissue remodeling, reconstruction of anal canal anatomy, and radical excision of pathologically altered tissues. Within each strategy, corresponding clinical treatment methods were systematized, allowing diverse modern technologies to be interpreted as specific implementations of a limited number of fundamental therapeutic mechanisms.

Conclusions. The proposed classification enables systematic organization of contemporary treatment methods for hemorrhoidal disease according to their underlying pathophysiological mechanisms and integrates them within a unified conceptual model. This approach provides a methodological basis for a more consistent interpretation of modern treatment technologies and may be applied in future comparative clinical studies.

Treatment tactics for patients with borderline resectable and locally advanced pancreatic cancer

V. M. Kopchak — 2026-03-31

Objective – to evaluate the outcomes of extended pancreatic resections in the treatment of patients with borderline resectable and locally advanced pancreatic cancer and to identify strategies for improving the effectiveness of these procedures.

Materials and methods. Between 2010 and 2023, a total of 874 pancreatic resections were performed for patients with pancreatic adenocarcinoma: 142 distal pancreatosplenectomies (16.2%), 706 pancreaticoduodenectomies (80.8%), and 26 total pancreatectomies (3.0%). The cohort included 388 females (44.4%) and 486 males (55.6%), with a mean age of 57.7±10.5 years (range: 22 – 81). Extended pancreatic resections were conducted in 202 (23.1%) patients, comprising 130 extended pancreaticoduodenectomies (64.4%), 58 extended distal pancreatosplenectomies (28.7%), and 14 extended total pancreatectomies (6.9%). A total of 144 (71.3%) patients underwent pancreatic resections with venous resections, 13 (6.4%) with arterial resections, 3 (1.5%) with combined vascular resections, and 42 (20.8%) with resections of adjacent organs.

Results. Postoperative complications were observed in 248 patients (36.9%) in the standard resection group and in 84 patients (41.6%) in the extended resection group (χ²=1.4; p=0.22), with no statistically significant difference. The mortality rate was 2.6%, with 23 deaths: 16 (2.4%) after standard pancreatic resections and 7 (3.5%) after extended pancreatic resections, indicating no statistically significant difference (χ²=0.71; p=0.39). Implementation of a personalized treatment algorithm increased the median survival of patients with borderline resectable and locally advanced pancreatic head cancer from 19 to 28 months (χ²=1.7; p=0.18) and the five‑year survival from 22% to 28.5%. For patients with pancreatic cancer of the body and tail, median survival increased from 22 to 36 months (χ²=1.78; p=0.18) and five‑year survival from 24% to 34% (χ²=1.78; p=0.18).

Conclusions. The results suggest that morbidity and mortality after extended pancreatic resections are comparable to those observed after standard pancreatic resections. Extended resections are feasible and can increase the number of patients eligible for radical surgery. Implementation of the developed treatment algorithm was associated with improved median survival in patients with borderline resectable and locally advanced pancreatic cancer.

Acute skeletal muscle loss in surgically treated patients with severe infected necrotizing pancreatitis: a longitudinal ultrasound study

V. Teterina — 2026-03-31

Objective – to evaluate perioperative changes in ultrasound‑derived parameters of peripheral muscle mass, using the cross‑sectional area of the rectus femoris muscle as a representative measure, in patients undergoing surgery for severe acute pancreatitis complicated by infected necrosis. Additionally, changes in handgrip strength were assessed, and the association between ultrasound findings and computed tomography–derived muscle mass indices was analyzed.

Materials and methods. This prospective observational study was conducted at two clinical centers and included 28 patients aged 19 – 59 years who underwent surgery for infected necrotizing pancreatitis. The median length of hospital stay was 49 (39 – 59) days. Serial measurements of the cross‑sectional area (CSA) of the rectus femoris muscle were obtained using a portable ultrasound device equipped with a wireless high‑frequency linear transducer, and handgrip strength was assessed with a dynamometer at three clinically defined time points (T1–T3). Serial measurements were obtained at clinically defined time points reflecting the perioperative course of severe acute pancreatitis: the first examination was performed on day 8 (6 – 10) of hospitalization, and the second on day 29 (26 – 31). In a subgroup of 17 patients with available paired computed tomography (CT) scans, skeletal muscle area (SMA) at the L3 vertebral level was assessed, and the association between changes in ultrasound parameters and CT‑derived measurements was analyzed using Spearman’s rank correlation coefficient. Linear mixed‑effects models were applied to evaluate the longitudinal dynamics of skeletal muscle parameters.

Results. A statistically significant progressive decrease in CSA of the rectus femoris muscle (p<0.001) was observed during hospitalization. The total relative reduction in CSA between T1 and T3 was 20.5%. Modeling the length of hospital stay as a continuous variable confirmed an independent association between CSA decline and time (β=–0.025 cm²/day; p<0.001). The reduction in handgrip strength was even more pronounced (p<0.001), with a total relative decrease of 36.7% between T1 and T3. In the subgroup of patients with paired CT scans, ultrasound‑derived changes in CSA demonstrated a moderate positive correlation with changes in skeletal muscle area (SMA) at the L3 vertebral level (ρ=0.65; p=0.005), supporting the concordance between the two assessment methods.

Conclusions. Patients who underwent surgery for infected necrotizing pancreatitis demonstrated progressive deterioration in both morphological and functional skeletal muscle parameters during hospitalization. A more pronounced decline in muscle strength compared with ultrasound‑derived measures of muscle mass may reflect asynchronous functional and morphological changes in skeletal muscle in the context of severe acute pancreatitis complicated by infected necrosis. These findings support the clinical utility of a combined morphological and functional assessment of muscle status for the timely identification of acute secondary sarcopenia and optimizing nutritional and rehabilitation interventions in this patient population.

Changes in ZO-1 expression as an early indicator of treatment effectiveness in patients with chronic diabetic foot wounds

D. Yakymiv — 2026-03-31

Chronic diabetic foot wounds represent a persistent surgical challenge due to delayed healing, frequent complications, and high socioeconomic burden. Chronic hyperglycemia is known to impair epidermal barrier integrity, in part by altering the expression of tight junction proteins, including zonula occludens‑1 (ZO‑1).

Objective – to evaluate changes in ZO‑1 expression in chronic diabetic foot wounds following combined local therapy and to assess the potential role of ZO‑1 as an early molecular marker of epithelial barrier restoration.

Materials and methods. A prospective randomized study included 28 patients with chronic diabetic foot wounds. Patients were divided into an intervention group (n=14) treated with a combined spray–and–gel regimen containing collagen, hyaluronate, amino acids, trace elements (Zn, Cu), and antiseptic components, and a control group (n=14), receiving standard chlorhexidine dressings. Epidermal biopsy samples were obtained at baseline (Day 0) and after 10 days of treatment. ZO‑1 expression was assessed using Western blot analysis, followed by densitometric quantification.

Results. Patients receiving combined local therapy demonstrated a marked increase in ZO‑1 expression by Day 10 compared with baseline values, indicating restoration of intercellular junction integrity. No comparable changes were observed in the control group.

Conclusions. Combined local therapy promotes molecular recovery of the epidermal barrier in chronic diabetic foot wounds, as evidenced by increased ZO‑1 expression. These findings support the clinical relevance of ZO‑1 as an objective biomarker for treatment response in the surgical management of chronic diabetic wounds.

Implant rejection in alloplasty of abdominal hernias: analysis of causes and surgical correction methods

A. I. Moiseienko — 2026-03-31

Hernias of the anterior abdominal wall, particularly postoperative ones, remain an ever‑present problem in modern abdominal surgery. The introduction of alloplasty using mesh implants has significantly improved the results of surgical treatment of abdominal hernias, reducing the recurrence rate to 8 – 20% and with hybrid‑laparoscopic techniques to 2.7%. However, the use of mesh implants is accompanied by specific complications. Unsatisfactory results of the mesh integration process after alloplasty are explained by the distorted course of the local inflammatory reaction, namely, the transformation of aseptic inflammation into bacterial inflammation.

Objective – to systematize and generalize modern ideas and own experience in the surgical treatment of infectious complications of abdominal hernia alloplasty, analyze the causes of their occurrence, and identify promising areas for improving treatment outcomes.

Materials and methods. We studied 28 patients who had previously undergone abdominal hernia repair and subsequently developed inflammatory complications at the site of implantation. The diagnosis of mesh implant rejection was based on a comprehensive assessment of clinical, laboratory, instrumental, and morphological data. The presence of persistent clinical symptoms for a prolonged period after alloplasty was considered an indication for an in‑depth examination to exclude or confirm implant rejection and to determine the optimal treatment strategy for a particular patient. Laboratory tests, ultrasound, CT, or MRI were used for this purpose.

Results. The leading cause of implant rejection in the general group was chronic infection of the implantation site, detected in 46.4% of cases, which was combined with fistula formation in 28.6% of patients. In all 7 patients with inflammatory complications after alloplasty of inguinal hernias, complete explantation of the mesh implant, careful restoration of the normal anatomy of the inguinal canal, tissue sanitation, and excision of fistula passages with autoplasty in the presence of concomitant hernia recurrence were performed. Among patients with ventral hernias, complete explantation of the mesh was performed in 15 of 21 cases (71.4%), while partial explantation was performed in 6 cases (28.6%), prioritizing preservation of integrated areas.

Conclusions. Complications after alloplasty of ventral hernias, especially when the onlay method and heavy polypropylene meshes are used, account for 75.0% of cases of mesh implant rejection. The leading cause of implant rejection is chronic infection of the alloplasty area, whereas the formation of branched multiple fistulas is one of the most common clinical manifestations. Complete explantation of the infected implant, combined with autoplasty and vacuum drainage, is the method of choice for the surgical treatment of such complications. Partial explantation with staged reconstruction is possible in carefully selected patients with ventral hernias, but it is accompanied by longer treatment and increases the risk of recurrence.

Prognostic model of integral renal risk in infants after correction of congenital heart defects

M. H. Melnychenko — 2026-03-31

Renal complications and subclinical renal stress are frequent components of the early postoperative period in infants after cardiac surgical correction of congenital heart defects and require early risk stratification.

Objective – to develop a prognostic scoring index for assessing the integral renal risk index in infants after correction of congenital heart defects in the early postoperative period.

Materials and methods. A retrospective single‑center descriptive‑analytical study was conducted (n=101; age 1 – 12 months). The dependent variable was the integral renal risk index (a continuous scale of integral renal risk or stress) formed within the analysis of the early postoperative period. The following predictors were considered: disease severity, physical development as a proxy for nutritional status, class or complexity of the surgical intervention, syndromic or genetic features, creatinine level, and left ventricular ejection fraction. Multiple linear regression was constructed with diagnostics of assumptions (normality of residuals, linearity, homoscedasticity, multicollinearity assessed by the variance inflation factor, and influential observations).

Results. The model was statistically significant (F(6, 94)=9.82; p<0.001) and explained 38.5% of the variance in risk (adjusted R²=0.346). The largest independent contribution was made by the operation class (surgical complexity) (b=0.578; p<0.001), whereas ejection fraction demonstrated an inverse association with risk (b=–0.0167; p=0.016).

Conclusions. A scoring index, X, defined by a formula and within‑cohort thresholds (X>1 – high risk; X>1.5 – very high risk), is proposed. This index integrates perioperative burden and perfusion reserve and may be used for early nephroprotective management.