General Surgery <p style="font-weight: bold; color: #404040; font-size: 100%; padding-top: 0;">General Surgery is a peer-reviewed specialized scientific and practical journal for the surgical community of Ukraine with international participation</p> <p>Founded in May 2021</p> <div class="aligncenter" style="width: 100%; height: 0; border-top: 1px solid #dddddd; font-size: 0;">-</div> <p> </p> <table style="width: 663px;"> <tbody> <tr> <td valign="top" width="136px"><img src="" alt="" width="123" height="174" /></td> <td valign="bottom"><strong>Editor-in-Chief </strong><br />Yaroslav Susak<br />Doctor of Medicine, Professor, Head of the Department of Surgery with a Course of Emergency and Vascular Surgery, Bogomolets National Medical University</td> </tr> </tbody> </table> <p><em>General Surgery is a new peer-reviewed international journal.</em><br /><em>The editorial board consists of a group of leading scientists from Austria, Latvia, Germany, Turkey, Ukraine, and Sweden, who have outstanding professional and academic credentials. They act as ambassadors for the new English-language journal and, among other things, strongly support the idea of promoting the Ukrainian school of surgery, its knowledge pool, achievements and strivings around the world.</em></p> <div class="aligncenter" style="width: 100%; height: 0; border-top: 1px solid #dddddd; font-size: 0;">-</div> <p><strong>Founders: </strong>Bogomolets National Medical University, VIT-A-POL LLC</p> <p style="margin-top: .3em;"><strong>Сertificate of state registration: </strong>KB No 24849-14789Р granted May 7, 2021</p> <p style="margin-top: .3em;"><strong>Publisher:</strong> Publishing Company VIT-A-POL</p> <p style="margin-top: .3em;"><strong>Languages:</strong> English, abstracts in Ukrainian</p> <p><strong>Indexed in</strong> Index Copernicus, CrossRef, Vernadsky National Library of Ukraine, Google Scholar, Наукова періодика України</p> <p style="margin-top: .3em;"><strong>Frequency:</strong> 4 issues per year</p> <p><strong>ISSN:</strong> 2786-5584 (Print), 2786-5592 (Online)</p> <p><strong>DOI:</strong> 10.30978/GS<br />DOI (the digital object identifier of the CrossRef Bibliographic Reference System) are assigned for articles published in the journal</p> <p style="margin-top: .3em;"><strong>Website:</strong> <a href=""></a></p> <div class="aligncenter" style="width: 100%; height: 0; border-top: 1px solid #dddddd; font-size: 0;">-</div> en-US (Viktoriia Teterina (Вікторія Тетеріна)) (Olha Bernyk (Ольга Берник)) Sat, 30 Apr 2022 00:00:00 +0300 OJS 60 The effects of bariatric surgery procedures on the gut microbiota, features of genetically mediated predisposition to obesity, forecasting algorithms for surgical treatment outcomes. Literature review <p>Obesity is one of the major challenges facing modern medicine in the 21st century. Medically complicated obesity cases lead to a&nbsp;significant deterioration in quality of life and are associated with excess morbidity and increased mortality. According to the WHO, more than 24&nbsp;% of the world's population over 18 years of age is overweight. About 3.9 million people of working age died in 2018 due to obesity and its complications. Today, bariatric surgery is the most effective in treating obesity, as it allows achieving optimal metabolic outcomes. After bariatric surgery, the desired effect can be produced by the response of the intestinal microbiome to postoperative anatomical and physiological changes in the gastrointestinal tract.</p> <p><strong>The aim</strong> of this study was to conduct a&nbsp;comprehensive literature review and evaluate the effects of bariatric surgery on the human intestinal microbiome.</p> <p>The literature review revealed a&nbsp;stable correlation between quantitative and qualitative characteristics of the intestinal microbiota and bariatric surgery, regardless of the type of a&nbsp;bariatric surgical operation. Roux‑en‑Y Gastric Bypass, Mini‑Gastric Bypass and Sleeve Gastrectomy are the most commonly used bariatric operations in the world. The outcomes of these procedures show a&nbsp;sharp change in the proportion of different microbial phyla, including <em>Firmicutes</em>, <em>Bacterioides</em> and <em>Escherichia</em>, as well as changes in the gene expression parameters of these groups at different time periods after surgery.</p> <p>An increasing number of the reported bariatric interventions worldwide necessitates the study of pathophysiological mechanisms of intermicrobial relationships, which can contribute to better outcomes of surgical treatment of obesity and the development of algorithms for predicting them.</p> <p>&nbsp;</p> P. A. Kobzar Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Primary pancreatic lymphoma: a rare tumour that mimics pancreatic carcinoma. Clinical case <p class="RESUMEtext">Primary pancreatic lymphomas are extremely rare. Clinically, primary pancreatic lymphomas usually present with symptoms of pancreatic carcinoma. A&nbsp;localized and well‑circumscribed tumour that replaces most of the pancreatic gland and compression of the blood vessels are radiological features of lymphoma, which are similar to pancreatic adenocarcinoma. Many patients are diagnosed with lymphoma after radical resection. It’s a&nbsp;challenging clinical task for physicians, radiologists, and pathologists.</p> <p class="RESUMEtext">We report a&nbsp;case of primary pancreatic lymphoma that was confirmed by surgical resection. A&nbsp;60‑year‑old woman came to the clinic with non‑specific upper abdominal pain that lasted 8 weeks. Computed tomography (CT) scan showed a&nbsp;mass in the body of the pancreas, involving the superior mesenteric artery and the celiac trunk, and regional lymphadenopathy. Endoscopic ultrasound‑guided fine needle aspiration of the pancreatic mass was performed. A&nbsp;morphological pattern indicated ductal carcinoma. The tumour board determined the treatment plan (chemotherapy) for the patient. The patient underwent 3 courses of GEMCAP chemotherapy in our hospital. A&nbsp;follow‑up radiological exam showed no improvement. The chemotherapy regimen was changed to FOLFIRINOX. The patient underwent 6 courses of the FOLFIRINOX regimen.</p> <p class="RESUMEtext">A follow‑up magnetic resonance imaging of the pancreas showed tumour regression by more than 90&nbsp;% in comparison with the previous study. The patient underwent distal pancreatosplenectomy with standard lymph node dissection. Postoperative period was uncomplicated. These pathological results confirm the diagnosis of diffuse B‑cell lymphoma.</p> <p class="RESUMEtext"><strong>Conclusions.</strong> This case shows that lack of tissue can make histological examination of FNA specimens challenging and mistakes can happen due to rare occurrence of primary pancreatic lymphomas.</p> K. Kopchak, Y.  Dombrovsky, O. Kvasivka, V. Kopetskyi , V. Sumarokova Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Surgical management of a dog bite in a patient with comorbidities. Case study <p>Millions of people worldwide require urgent medical care annually due to bites and injuries inflicted by wild or domestic animals. Injured patients most frequently suffer from extensive and deep wounds resulting in traumatic shock of different degrees. The extensive wounds are characterized by severe damage to fascial muscles, tendons, bones, major vessels and nerve trunks. Therefore, the management of patients attacked by wild or domestic animals includes the elimination of life‑threatening conditions and the application of various techniques and methods of reconstructive plastic surgery and their combinations to preserve the injured areas of the body (most commonly limbs). In each particular case, the prognosis and the choice of the most effective reconstructive surgery technique for the treatment of a&nbsp;wound defect depend on the state of the deep structures of the injured limb. The «reconstructive ladder principle» ensures the selection of the most appropriate treatment strategy, as it focuses on the nature of the injury and the patient’s overall health status, thus providing an adequate assessment of all possible surgical risks, general postoperative complications and challenges in wound healing. This algorithm allows prioritizing the most beneficial techniques from simple to difficult, as well as considering the «second line» methods. The «second line» methods are defined as simpler techniques that may be applied in case of some complications occurring after the administration of the primary method. Some additional difficulties may be experienced throughout the period of wound management in children and the elderly, in patients with complicated comorbidities and exacerbation of chronic diseases.<br>This article presents a&nbsp;case study of a&nbsp;patient undergoing the treatment for an extensive and deep bite wound that is complicated by acute coronary syndrome and severe cardiogenic shock in the early postoperative period.</p> P. O. Badiul, S. V. Sliesarenko, O. V. Nosulko, O. I. Rudenko Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Prospective analysis of surgical and functional outcomes after total proctocolectomy with ileal pouch-anal anastomosis in 86 patients with ulcerative colitis <p>Proctocolectomy with an ileal pouch‑anal anastomosis is currently considered the procedure of choice for the majority of patients with ulcerative colitis. Certain controversies about pouch design and pouch‑anal anastomosis technique remain a&nbsp;matter of debate, and possible advantages of laparoscopic approach are still being discussed.</p> <p><strong>Objective&nbsp;</strong>— to investigate short‑term and long‑term outcomes of laparoscopic and open restorative proctocolectomy for UC in terms of postoperative morbidity and pouch function depending on the three types of construction of a&nbsp;neorectum described in our research.</p> <p><strong>Materials and methods.</strong> 86 patients with inflammatory bowel disease underwent one‑stage or two‑stage restorative proctocolectomy. The two ileal pouch configurations were used: S‑pouch&nbsp;— in 16 patients and J‑pouch&nbsp;— in 70 patients. Removal of the distal rectum and ileal pouch‑anal anastomosis were performed using transanal distal rectum mucosectomy followed by a&nbsp;handsewn pouch‑anal anastomosis (n&nbsp;=&nbsp;45) or a&nbsp;double‑stapled technique (n&nbsp;=&nbsp;31). Laparoscopic approach was applied in 39 patients, and open surgery&nbsp;— in 47 patients. The short‑term (30 days after surgery) and long‑term surgical outcomes were prospectively studied. The analysis of functional outcomes was based on the number of bowel movements a&nbsp;day, episodes of fecal incontinence, seepage, and urgency. Instrumental investigation included measurement of the anal sphincter pressures and ileal pouch threshold volume as well as the study of its residual volume. Statistical analysis was performed using SPSS statistical software.</p> <p><strong>Results.</strong> There was no postoperative mortality. In the laparoscopic group, 4&nbsp;(10.3&nbsp;%) patients had early postoperative complications compared with 13&nbsp;(27.7&nbsp;%) patients in the open surgery group, but the difference was not statistically significant (Fisher exact test value is 0.0579 at p&nbsp;&lt;&nbsp;0.05). Pouch failure occurred in 4 patients. The second‑stage laparoscopic restorative procedure revealed the abdominal cavity almost free of adhesions in 19&nbsp;(86.4&nbsp;%) patients after laparoscopic total colectomy. The total number of early and late mucosectomy complications was significantly higher, 12&nbsp;(75.0&nbsp;%) vs. 10&nbsp;(26.0&nbsp;%) (p&nbsp;=&nbsp;0.0018), in patients managed with a&nbsp;handsewn S&nbsp;pouch‑anal anastomosis than in patients treated with a&nbsp;J‑pouch‑anal anastomosis. Good functional outcomes were observed in 44&nbsp;(51.0&nbsp;%) patients. A&nbsp;strong negative correlation was found between the pouch threshold volume and the number of bowel movements per 24 hours (r&nbsp;=&nbsp;–0.7347, p&nbsp;&lt;&nbsp;0.0001). The seepage episodes were detected in 30&nbsp;(34.8&nbsp;%) patients. The resting anal sphincter pressure was the only measured parameter which correlated accurately with the number of day and night seepage episodes (r&nbsp;=&nbsp;–074, p&nbsp;&lt;&nbsp;0.0001).</p> <p><strong>Conclusions.</strong> Good functional outcomes of construction of a neorectum were associated with the resting anal sphincter pressure (≥ 30 mm Hg) and ileal pouch threshold volume (150 — 250 ml).&nbsp;The S‑shaped and J‑shaped pouches demonstrated the same functional outcomes and posed similar risks. The S‑pouch was associated with a&nbsp;higher postoperative morbidity (p&nbsp;=&nbsp;0.0018). There was no significant difference between laparoscopic and open surgery groups in terms of morbidity rate and functional outcomes. However, it was much easier to perform the second‑stage surgery after laparoscopy due to less adhesion formation.</p> M. Kucher Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 A genomically stable molecular type of gastric cancer as a predictor of peritoneal relapse after radical surgical treatment <p>Peritoneal metastases are commonly associated with gastric cancer (GC) recurrence after radical treatment. Thus, patients at a&nbsp;high risk of peritoneal relapse require adjuvant intraperitoneal chemotherapy during the initial treatment. Along with clinical and morphological predictors of peritoneal relapse, another approach in surgical oncology is proving to be promising today. It refers to the prediction of the risk of developing metachronous peritoneal metastases in various molecular types of GC.</p> <p><strong>Objective</strong>&nbsp;— to study the risk of peritoneal relapse in patients with the genomically stable type of GC in comparison to its other molecular types.</p> <p><strong>Materials and methods. </strong>37 patients with GC were enrolled into the study and evaluated after the radical treatment. 19&nbsp;(51.4&nbsp;%) patients formed a&nbsp;subgroup with peritoneal relapse and 18 patients (48.6&nbsp;%) were included into a&nbsp;subgroup without metachronous carcinomatosis in the long term. All patients underwent immunohistochemical study for the E‑cadherin (CDH1 gene) expression in a&nbsp;gastric tumor. The genomically stable molecular type was identified on the basis of the aberrant E‑cadherin (CDH1‑mutated) tumor phenotype detection.</p> <p><strong>Results.</strong> There was a statistically significant difference (p = 0.022, χ<sup>2</sup>&nbsp;=&nbsp;5.22) in the degree of aberrant E‑cadherin expression in subgroups of patients with and without peritoneal relapse&nbsp;— 68.4 and 33.3&nbsp;%, respectively. Hence, it was noted that the genomically stable molecular type had a&nbsp;significant influence on the risk of peritoneal recurrence: the 2‑year peritoneal relapse‑free survival of GC patients with E‑cadherin of aberrant type was 31.6&nbsp;%, and in GC patients with wild‑type E‑cadherin expression&nbsp;— 71.4&nbsp;% (p&nbsp;=&nbsp;0.022). The 2‑year overall survival of GC patients with aberrant type E‑cadherin expression was 36.8&nbsp;%, whereas in GC patients with E‑cadherin of the wild type&nbsp;— 77.8&nbsp;% (p&nbsp;=&nbsp;0.003).</p> <p><strong>Conclusions.</strong> The study found that the genomically stable molecular type of GC may serve as a&nbsp;predictive factor associated with an increased probability of peritoneal relapse, as well as a&nbsp;prognostic factor due to its negative impact on patient prognosis. The genomically stable molecular type of GC may be used as a&nbsp;tool for forming a&nbsp;cohort of patients with indications for adjuvant intraperitoneal therapy.</p> <p>&nbsp;</p> R. Yarema, M. Оhorchak, O. Petronchak, R. Huley, P. Hyrya, Y. Kovalchuk, V. Safiyan, O. Rilinh, M. Matusyak Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 The impact of minimally invasive palliative decompression of bile ducts on quality of life in patients with distal malignant mechanical jaundice <p>Palliative treatment for mechanical jaundice is aimed at improving patient quality of life (QoL) and prolonging life. The current QoL studies indicate that there is limited evidence on various techniques for decompression of bile ducts (BD) in terms of their impact on quality of life in patients with distal malignant mechanical jaundice, and their data are contradictory.</p> <p><strong>The aim</strong> of the study is to evaluate the effect of minimally invasive palliative techniques on QoL in patients with distal mechanical jaundice (MJ) after palliative decompression of bile ducts.</p> <p><strong>Materials and methods.</strong> From 2017 to 2021, 98 patients who underwent palliative decompression of bile ducts for distal MJ of malignant origin were examined. A&nbsp;validated MOS SF‑36 questionnaire was used to assess patient QoL. The survey was conducted before the minimally invasive intervention and 2 months after it. Depending on the technique used for decompression of BD, patients were divided into the following groups: percutaneous transhepatic biliary drainage (PTBD)&nbsp;— 25, internal‑external transpapillary biliary drainage (IETBD)&nbsp;— 19, internal‑external biliary‑jejunal drainage (IEBJD)&nbsp;— 29, and endoscopic retrograde biliary stenting (ERBS)&nbsp;— 25.</p> <p><strong>Results.</strong> Before treatment, a&nbsp;low level of patient QoL was detected in all groups on all scales of physical and psychological components of health (all p&nbsp;&gt;&nbsp;0.05). After 2 months, in the PTBD group, the indicator of the Mental Component Summary (MCS) decreased by an average of 6.9&nbsp;±&nbsp;1.2 points (due to the deterioration of the indicator of social functioning scales by 12.5&nbsp;±&nbsp;5.0 points and mental health by 11.1&nbsp;±&nbsp;1.8 points), while the indicator of the Physical Component Summary (PCS) improved by 11.3&nbsp;±&nbsp;1.1 points. In the IETBD and IEBJD groups, there was an improvement in MCS (by 11.7&nbsp;±&nbsp;1.3 points and 13.0&nbsp;±&nbsp;1.1 points, respectively) and PCS (by 5.2&nbsp;±&nbsp;1.2 and 8.6&nbsp;±&nbsp;1.1 points). With regard to MCS and PCS, slight improvement (by 4.7&nbsp;±&nbsp;2.2 and 2.0&nbsp;±&nbsp;1.9 points) was observed in the ERBS group.</p> <p><strong>Conclusions.</strong> The IEBJD technique provided important advantages in comparison with other minimally invasive palliative techniques for decompression of BD in terms of its impact on patient QoL. Patients in the IEBJD group had better PCS scores (on average, 47.3&nbsp;±&nbsp;1.3 points) compared to the IETBD (42.1&nbsp;±&nbsp;1.5 points) and ERBS (39.1&nbsp;±&nbsp;1.3 points, p&nbsp;&lt;&nbsp;0.05) groups, and those in the PTBD group (46.2&nbsp;±&nbsp;1.4 points) had better scores than patients in the IETBD group (p&nbsp;&lt;&nbsp;0.05). In the IETBD and IEBJD groups, MCS scores were better 41.9&nbsp;±&nbsp;1.1 and 40.3&nbsp;±&nbsp;1.1 points, respectively) compared to the PTBD (22.6&nbsp;±&nbsp;0.9 points) and ERBS (34.0&nbsp;±&nbsp;1.1 points, p&nbsp;&lt;&nbsp;0.05) groups, and in the ERBS group, they were better than in the PTBD group.</p> <p>&nbsp;</p> Y. M. Susak, L. Y. Markulan, R. Y. Palytsya, V. V. Teterina Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Cervical mediastinoscopy in diagnosis and treatment of lung cancer <p class="RESUMEtext">Lung cancer remains the leading cause of cancer mortality. It ranks first in the incidence of cancer in the world. According to the European Association of Oncologists, the annual incidence of lung cancer is increasing with every passing year and amounts to about 1.8 million new cases worldwide. Men have a&nbsp;higher prevalence of lung cancer (33.8 per 100,000) than their female counterparts (13.5 per 100,000). In most cases, it is diagnosed at an advanced stage (III<span style="font-family: 'Times New Roman','serif';"> </span>—<span style="font-family: 'Times New Roman','serif';"> </span>IV), which is characterised by mediastinal lymphadenopathy. Early detection of lung cancer allows seeking early treatment. Lung cancer screening is used to find a&nbsp;tumour and/or lung cancer metastasis, determine its location and size as well as its morphological verification.</p> <p class="RESUMEtext"><strong>Objective</strong> — to define the most accurate invasive and non‑invasive methods of verification and diagnosis of mediastinal lymphadenopathy and improve diagnosis and treatment of lung cancer through the extensive use of cervical mediastinoscopy and creation of an algorithm for its optimal use.</p> <p class="RESUMEtext"><strong>Materials and methods.</strong> The study included 146 patients. A&nbsp;wide range of clinical, laboratory, endoscopic (Endobronchial ultrasound transbronchial needle aspiration (EBUS‑TBNA), Cervical Mediastinoscopy (CM)), radiographical (Computed tomography (CT), Positron emission tomography (PET)), morphological, immunohistochemical and statistical methods were used. Statistical analysis was performed using Statistics for Windows Version 10.0 (Stat Soft Inc., USA).</p> <p class="RESUMEtext"><strong>Results.</strong> The study involved 146 patients who underwent screening for mediastinal lymphadenopathy using mediastinoscopy. According to the laboratory findings, 98 patients had lung cancer. The rest of the cases were presented by other pathologies. Colorectal and stomach cancers were most commonly seen. In one case, the patient had a&nbsp;comorbidity, a&nbsp;combination of lung cancer and colorectal cancer.</p> <p class="RESUMEtext"><strong>Conclusions.</strong> Mediastinoscopy is the most effective diagnostic method for mediastinal lymphadenopathy, especially in lung cancer.</p> R. Vereshchako, I. Sukhin, O. Piskorskyi Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Nutritional support for patients in general surgery <p>The modern stage of development of surgery, especially minimal invasive technologies, has significantly changed the surgeons' thoughts about the perioperative period. Until the end of the twentieth century, pre‑ and postoperative fasting was the most important requirement in planned surgery. It was believed that it could help to avoid complications both during surgery and in the early postoperative period. H. Kehlet in his fundamental work outlined the factors that allowed to accelerate the patient's recovery after surgery, namely: the absence of preoperative fasting.</p> <p><strong>Objective</strong>&nbsp;— to evaluate the effectiveness of nutritional support for surgical patients within ERAS (Enhanced Recovery After Surgery) and ESPEN (European Society for Clinical Nutrition and Metabolism) protocols.</p> <p><strong>Materials and methods.</strong> This research included both traditional laparoscopic cholecystectomy (177 cases) and single‑port transumbilical cholecystectomy (8); among laparoscopic bariatric interventions, the major part was represented by classical Roux‑Y gastric shunting (28), as well as sleeve gastrectomy (5) and mini‑gastric shunting (4); among 123 different laparoscopic hernioplasties, in 64 cases transabdominal preperitoneal (TAPP) was performed for bubonocele, intraperitoneal onlay mesh (IPOM) for postoperative ventral and umbilical hernias (59), laparoscopic crurography and fundoplication with and without alloplasty (33). For each type of surgery two groups we identified: control and experimental. Both groups were followed by ERAS protocols in addition to nutritional support. With the prior consent of patients before surgery: the experimental group received full perioperative nutritional support according to our local protocols using protein‑enriched sip feeding formula Nutridrink Protein, the control group followed the traditional scheme of fasting during 12 hours before surgery and received regular drinking water instead of protein mixtures at the first postoperative day.</p> <p><strong>Results.</strong> We found statistically significant difference between control and experimental groups in assessing of two important parameters as hunger and weakness. The hunger after laparoscopic cholecystectomy was 1.5&nbsp;times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic hernia repair&nbsp;— 1.7 times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic crurography and fundoplication&nbsp;— 1.26 times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic bariatric intervention&nbsp;— 1.43 times, and after laparoscopic colon intervention&nbsp;— 1.9 times lower in the experimental group. The weakness after laparoscopic cholecystectomy was 1.8 times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic hernia repair&nbsp;— 1.31 times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic crurography and fundoplication&nbsp;— 1.68 times (p&nbsp;&lt;&nbsp;0.001), after laparoscopic bariatric intervention&nbsp;— 1.67 times (p&nbsp;&lt;&nbsp;0.001), and after laparoscopic colon intervention&nbsp;— 1.38 times (p&nbsp;=&nbsp;0.006) stronger in the control group.</p> <p><strong>Conclusions.</strong> Traditional long‑term preoperative fasting is inappropriate. Combined with other ERAS postulates, perioperative nutritional support for surgical patients has a&nbsp;great chance of success. In our research, early restoration of oral nutrition significantly decreases hunger and general weakness in the early postoperative period, which allows the patient quickly return to full life.</p> <p>&nbsp;</p> O. Y. Ioffe, O. P. Stetsenko, M. S. Kryvopustov, Y. P. Tsiura, T. V. Tarasiuk Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Effectiveness of the Erbisol® class in complex treatment of patients with liver cirrhosis <p>Liver cirrhosis (LC) frequently results in severe complications, high mortality rate and disability in patients suffering from this disease, thus necessitating the study of its course, diagnosis and management. The principle of gradual elimination of pathological syndromes is fundamental in the treatment of LC. Complex therapy requires the use of medicines that act on the general links of pathogenesis. As LC causes damage to the cellular structure of the liver as well as interferes with the normal functioning of other organs and systems, it requires the prescription of medicines with metabolic and immunomodulatory properties. Experimental and clinical results of trials of <em>Erbisol</em> injections necessitated the study of their therapeutic properties in patients with LC. Immunomodulation, hepatoprotection and hepatoreparation play a&nbsp;crucial role in the management of LC.</p> <p><strong>Objective</strong> — to investigate the effectiveness of the <em>Erbisol</em><sup>®</sup> class medications in complex treatment of patients with liver cirrhosis.</p> <p><strong>Materials and methods.</strong> The analysis of treatment outcomes in 57 patients with LC was carried out and is presented in this study. Patients were divided into two groups with 28 patients (15 males and 13 females) in the main group and 29 patients (18 males and 11 females) in the control group. All patients received a&nbsp;comprehensive basic therapy for the management of LC. The main group was also prescribed intramuscular injections of the <em>Erbisol</em><sup>®</sup> class medicines (<em>Erbisol</em><sup>®</sup> <em>Extra</em>, <em>Erbisol</em><sup>®</sup> <em>Ultrapharm</em>) that were administered according to the manufacturer’s instructions (Erbis Ukraine, https// Specific guidelines were followed during the examination of the patients. In both groups, patients with compensated LC had their liver function assessed according to the Child‑Pugh scoring system. Their point scores were added and classified as class B: 8 — 9 points. All patients were distributed according to gender, age, duration of the disease and severity of the main syndromes. The effectiveness of treatment was evaluated based on clinical symptoms, severity, blood tests, elastography ultrasound and Doppler ultrasonography.</p> <p><strong>Results.</strong> The use of <em>Erbisol</em><sup>®</sup> medicines significantly improved the dynamics of the clinical course of cirrhosis, relieved astheno‑vegetative disorders, had a&nbsp;pronounced immunocorrective effect that was evidenced by changes in the ratio of serum protein fractions. In the main group, treatment outcomes were characterized by moderate regeneration of the liver parenchyma. It was confirmed by hemodynamic parameters and elastography data. The complex use of <em>Erbisol</em><sup>®</sup> drugs helps to slow down and regress fibrosis, contributing to the favorable course of the disease.</p> <p><strong>Conclusions.</strong> Complex treatment with the <em>Erbisol</em><sup>®</sup> class medications had a&nbsp;positive action on clinical and blood biochemical parameters and ensured a&nbsp;membrane‑protective effect, regression of fibrosis, and improved hepatic blood flow.</p> <p>&nbsp;</p> Y. Susak, I. Slychko, O. Nikolayenko, O. Dyrda, V. Korobko, M. Maksymenko Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Professor Volodymyr Opanasovych Karavaiev — surgeon, scientist and innovator <p>The article presents the professional and scientific path of Professor Volodymyr Opanasovych Karavaiev — the first professor of surgery, first head of the department, first organizer and first dean of the medical faculty of St.&nbsp;Volodymyr University, who worked at the university clinic (now Kyiv City Clinical Hospital No18).</p> L. G. Zavernyi, T. V. Tarasiuk, Y. P. Tsiura, M. S. Kryvopustov Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300 Transplantation in Turkey and region <p>The article provides insight into significant milestones in the history of organ transplantation in Turkey and region.</p> <p>In 1975, we were the first in Turkey to perform living‑related kidney transplantation and, in 1978, deceased‑donor kidney transplantation, using an organ supplied by Eurotransplant. In 1979, the law on harvesting, storage, grafting, and transplantation of organs and tissues was enacted. The first local deceased‑donor kidney transplantation was performed by our team in 1979. The first successful deceased‑donor liver transplantation, which was a&nbsp;groundbreaking surgery procedure for Turkey, the Middle East and Northern Africa, was carried out by our team in 1988. In 1990, we were the first not only in Turkey but also in the Middle East region as well as Europe to perform pediatric living‑related segmental liver transplantation. One month later, an adult‑to‑adult living‑related liver transplant (a left lobe) was successfully performed for the first time in the history of organ transplantation. On May 16, 1992, we carried out the first combined liver‑kidney transplantation from a&nbsp;living‑related donor, which was the first operation of its kind in the world. Between November 1975 and October 2021, we performed 3,256 kidney transplantations at Hacettepe University Hospitals&nbsp; . Since 1988 to date, we have carried out 695 liver transplantations at Baskent University. According to the registry of the Ministry of Health, from 2002 to 2021, 46,115 kidney transplants were performed nationwide, as compared with 17,868 liver transplants, 1,153 heart transplants and 198 pancreas transplants. In 2001, the Ministry of Health established the National Coordination Center as an umbrella organization to promote transplantation activities, especially deceased‑donor organ procurement. Despite constantly increasing overall living‑donor transplant rate across the country, overall deceased‑donor transplant rate is still far below the desired level.</p> <p>&nbsp;</p> M. Haberal Copyright (c) 2022 General Surgery Sat, 30 Apr 2022 00:00:00 +0300