General Surgery

Antimicrobial resistance of combat-related infections. Literature review

O. V. Burakov — Thu, 31 Jul 2025 00:00:00 +0300

The article compiles information from scientific reports published between 2011 and 2024 , indexed in both Ukrainian and international databases. The studies focus on the microflora of combat wounds and the antimicrobial resistance of primary pathogens responsible for purulent‑septic complications in patients from conflict zones. We analyzed the etiological structure of common wound infections and their antibiotic resistance in military personnel with combat‑related soft tissue injuries who were evacuated from the combat zone in eastern Ukraine.

Clinical approach to the treatment of metastatic skin melanoma. Сase study

Thu, 31 Jul 2025 00:00:00 +0300

Melanoma is an aggressive disease that accounts for approximately 75% of skin cancer‑related deaths. The primary objectives of surgery in metastatic disease are symptom relief and debulking. As effective systemic treatment prolongs survival in a patient population with advanced disease, the role of local palliative therapy potentially increases. When considering palliative surgery, it is crucial to weigh the potential risks of surgical complications against the burden caused by the symptomatic lesions.

We present a case report of melanoma TхNхM1c metastasis to the skin in the right supraclavicular area with disintegration and bleeding, metastatic lesions in the cervical, axillary, and subpectoral lymph nodes bilaterally, and metastatic lesions in the left adrenal gland, stage IV. The patient was urgently hospitalized with manifestations of diffuse bleeding associated with tumor disintegration. According to the treatment history, the patient has been receiving targeted chemo‑immunotherapy since 2022. The pain syndrome intensified, and periodic episodes of bleeding from the tumor were observed. Сytoreductive surgery tactics were discussed by the multidisciplinary team and agreed upon with the patient. Тhe patient insisted on removing the tumor despite the risks of the operation. This clinical study deals with a controversial, yet clinically required, palliative care method for preserving and improving the quality of life with this diagnosis. This case highlights the aggressive nature of generalized melanosis, characterized by a rapid clinical course and limited response to traditional targeted chemo‑immunotherapy. The difficulties encountered in the diagnosis and treatment of this aggressive form of metastatic melanoma underscore the need for early detection, tailored therapeutic approaches, and ongoing research efforts to improve treatment outcomes in such cases.

A clinical case of surgical treatment of complicated chronic venous insufficiency using the principles of hemodynamic management

I. V. Kolosovych, K. O. Korolova — Thu, 31 Jul 2025 00:00:00 +0300

Chronic venous disease is a widespread condition that involves telangiectasias, reticular veins, varicose veins, and venous ulcers. In addition to the well‑known manifestations and complications, long‑term persistent chronic venous insufficiency (CVI) can become a factor that contributes to the development of infectious processes in the skin and subcutaneous fat. If the inflammatory lesion spreads deeper, phlegmon and deep vein thrombosis may occur. 20% to 50% of patients suffering from deep vein thrombosis develop post‑thrombotic syndrome.

A 59‑year‑old patient turned to the department of surgery with complaints of severe swelling of the right lower limb, darkening and thickening of the skin, the presence of several wounds from which pus periodically oozed, varicose veins, intermittent pain, and a feeling of distension in the affected limb. A year ago, she was hospitalized with recurrent erysipelas of the right lower limb, which was complicated by phlegmon and required surgery. Over the past year, she had noticed severe swelling of the limb, and the right lower leg had darkened considerably. During ultrasound Doppler mapping, we detected signs of past deep vein thrombosis with partial recanalization at the level of the popliteal vein, incompetence of the saphenofemoral junction, dilation of the great saphenous vein and its tributaries, and incompetence of the perforating veins in the lower third of the leg. The surgical intervention followed the principles of hemodynamic management. After ten and a half months, the patient was fully satisfied with the treatment outcomes. The limb showed no swelling, hyperpigmentation significantly decreased, and the chronic wounds completely healed.

For patients with complicated CVI, a history of inflammatory skin and subcutaneous fat diseases, and an incompetent deep venous system, hemodynamic conservative treatment or CHIVA (Cure Conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire) is the preferred option. This technique requires a detailed ultrasound Doppler mapping of the venous network and is personalized for each patient. This treatment approach can yield the most stable long‑term results, the disappearance of all or most symptoms of CVI, and favourable cosmetic outcomes.

Clinical-epidemiological characteristics and etiological structure of benign mechanical jaundice syndrome: an 11-year single-center study

M. V. Maksymenko, Y. M. Susak, V. M. Dorosh, O. M. Lobanova, R. O. Havryliuk — Thu, 31 Jul 2025 00:00:00 +0300

Benign mechanical jaundice (BMJ) is a common condition in gastroenterological and surgical practice. Despite its clinical significance, most studies involve mixed etiologies (benign and malignant), complicating the assessment of the features specific to benign forms. Data on the seasonality, trends in hospitalization frequency, and clinical‑demographic characteristics of patients with BMJ remain limited.

Objective – to analyze the etiological structure, demographic profile, clinical presentation, hospitalization trends, and seasonality of benign mechanical jaundice based on 11 years of single‑center data.

Materials and methods. A retrospective‑prospective single‑center study was conducted involving 1,187 patients diagnosed with BMJ and hospitalized at Kyiv City Clinical Hospital of Emergency Care between 2013 and 2024. The diagnosis was based on clinical, laboratory, and imaging findings, with malignant pathology excluded. Descriptive, correlation, regression, and variance statistics were applied.

Results. The most common cause of BMJ was choledocholithiasis (73.6%), followed by indurative pancreatitis (7.7%), major duodenal papilla stenosis (7.1%), and Mirizzi syndrome (2.9%). Females predominated (57.8%), and the mean age was 64.7±14.3 years. Seasonal variation was statistically significant (p<0.001), with peaks in January, May, and November. A moderate positive correlation was observed between total bilirubin levels and time to hospitalization (r=0.482; p<0.001). A gradual increase in BMJ cases from 2014 to 2021 was noted (R²=0.47).

Conclusions. Choledocholithiasis is the leading cause of benign mechanical jaundice. Patients typically present late, with higher bilirubin levels correlating with delayed hospitalization. A clear pattern of seasonality was identified, which may inform improved healthcare resource planning. This study is the first in Ukraine to provide a comprehensive analysis of benign mechanical jaundice in a large cohort with the exclusion of malignant cases.

The effectiveness of laparoscopic choledochoduodenostomy for management of persistent common bile duct stones and advanced malignant obstructive jaundice

V. V. Grubnik, Y. V. Grubnik, V. V. Ilyashenko, M. Y. Grubnik, V. V. Grubnyk — Thu, 31 Jul 2025 00:00:00 +0300

Endoscopic clearance of common bile duct (CBD) stones and stenting for distal biliary obstruction are standard treatments, but can fail in cases of large calculi or advanced malignancy. Laparoscopic choledochoduodenostomy (LCCD) offers an internal bypass of the obstructed bile duct.

Objective – to evaluate the safety and effectiveness of LCCD in patients with persistent CBD stones after failed endoscopic clearance and in those with advanced malignant obstructive jaundice.

Materials and methods. We reviewed 55 patients who underwent LCCD at our center between 2018 and 2024. Of these, 26 patients had large CBD stones not cleared by endoscopic retrograde cholangiopancreatography, and 29 had unresectable distal malignant obstruction (pancreatic or ampullary carcinoma). All procedures were performed laparoscopically using five trocars, with a longitudinal choledochotomy and duodenotomy, a side‑to‑side biliary–enteric anastomosis hand‑sewn with absorbable barbed sutures (V‑Loc™ 3‑0), and concurrent cholecystectomy. Perioperative outcomes, complications, and follow‑up results were analyzed.

Results. LCCD was completed successfully in all 55 patients with no conversions to open surgery. The mean operative time was 76 minutes (range: 55 – 110 minutes). There were no major postoperative complications or 30‑day mortality. The average hospital stay was 5.2±2.1 days. Stone patients had 92% clearance of CBD stones with no residual obstruction or recurrent cholangitis observed over a follow‑up of up to 5 years. In the malignant group, jaundice was effectively palliated in all cases, with no patient requiring repeat biliary bypass surgery during their remaining life span.

Conclusions. Laparoscopic choledochoduodenostomy proved to be a safe and effective procedure for both complex CBD stones after failed endoscopic retrograde cholangiopancreatography and for palliative relief of malignant obstructive jaundice. The technique achieved durable biliary drainage with minimal morbidity and short hospital stay. LCCD should be considered as an alternative when endoscopic management is unsuccessful or not feasible, offering definitive resolution of CBD stones and excellent palliative outcomes in advanced malignancies.

Endoscopic transluminal interventions and percutaneous drainage in acute infected necrotizing pancreatitis: experience of a specialized center

Y. M. Susak, N. V. Puzyr — Thu, 31 Jul 2025 00:00:00 +0300

Acute infected necrotizing pancreatitis is a life‑threatening complication. Over the past 25 years, the introduction of minimally invasive techniques has significantly improved treatment outcomes. However, variations in disease progression, anatomical characteristics, and the need for optimal personalized invasive strategies remain subjects of ongoing debate.

Objective – to evaluate and compare the treatment outcomes of acute infected necrotizing pancreatitis with peripancreatic and combined (parenchymal + peripancreatic) lesions, using endoscopic transluminal interventions versus the traditional «step-up» approach.

Materials and methods. A retrospective study involving 67 patients (mean age – 50.5±10.9 years) was conducted from 2021 to 2024. Group 1 (n=28) underwent endoscopic transluminal interventions (ETI), including endoscopic necrosectomy when necessary, while Group 2 (n=39) was treated using the traditional “step‑up” approach, which involved percutaneous drainage (PD) and open necrosectomy if indicated. There were no significant differences between the groups in baseline characteristics or in the size of the walled-off pancreatic necrosis (WON). Clinical success was categorized as complete, partial, or absent. Statistical analysis was performed using χ² and the Mann‑Whitney U test.

Results. The ETI group required fewer repeat procedures: a single procedure was sufficient for 50% of patients in Group 1, whereas in Group 2, the majority of patients needed ≥3 procedures (p=0.013). Complete clinical success was achieved in 64.3% of patients in Group 1, compared to only 25.6% in Group 2 (p=0.004). External pancreatic fistulas occurred only after PD (12.8%, p=0.049). The mortality rate in the ETI group was lower (10.7% vs. 23.1%), although this difference was not statistically significant (p=0.193). Additionally, Group 1 had a shorter average hospital stay (56.2±27.2 days) compared to Group 2 (63.4±23.7 days).

Conclusions. Endoscopic transluminal interventions within a multidisciplinary “step‑up” approach are safer and more effective than isolated percutaneous drainage. ETI reduce the need for repeat interventions, lower the incidence of complications, and contribute to improved clinical outcomes in cases of acute infected necrotizing pancreatitis. PD and ETI are not mutually exclusive and can be incorporated into hybrid treatment strategies.

Minimally invasive techniques in stage I–II chronic hemorrhoids: outcomes and prioritization

L. S. Bilianskyi, I. V. Voloshyn — Thu, 31 Jul 2025 00:00:00 +0300

Various minimally invasive techniques are widely used in the treatment of stage I – II chronic hemorrhoids (CH), including rubber band ligation (RBL), transanal hemorrhoidal dearterialization (THD), laser vaporization (LV), among others. Bipolar vaporization (BPV) is a novel and promising method of thermal tissue destruction using the EK‑300M (Svarmed, Ukraine) bio‑welding generator. Its effectiveness compared to other techniques remains insufficiently studied.

Objective – to compare the outcomes of treating complicated stage I – II CH using four minimally invasive techniques (BV, LV, THD, RBL) and to determine their priority ranking.

Materials and methods. The study included 118 patients (67 men and 51 women, aged between 19 and 70 years; the mean age was 43.1±12.5 years) with symptomatic stage I – II CH resistant to conservative therapy. Patients were divided into four groups according to the applied method: BPV (n=32), LV (n=21), THD (n=23), and RBL (n=42). The following parameters were assessed: duration of the procedure, frequency of intraoperative complications, dynamics of symptoms (pain, prolapse, bleeding, itching, soiling), recurrence rate, and patient satisfaction at 12‑month follow‑up.

Results. All techniques demonstrated an adequate level of effectiveness and safety. The 12‑month recurrence rates were BPV – 3.1%, LV – 4.8%, THD – 13%, and RBL – 26.2%. The highest satisfaction level (8 – 9 points) was observed in the BPV and LV groups (> 90% of patients). BPV and LV showed the best clinical efficacy and stability of outcomes. THD ranked third in terms of effectiveness, while RBL had the lowest priority due to the high recurrence rate.

Conclusions. Considering clinical outcomes, availability, and cost, bipolar vaporization can be recommended as a priority method for the treatment of stage I – II CH. Further multicenter studies are needed to confirm its long‑term efficacy.

Clinical-anamnestic characteristics and quality of life in patients with the Cajal subtype of chronic slow-transit constipation

I. M. Leshchyshyn, L. Y. Markulan, Y. M. Susak, O. I. Okhotska, P. L. Byk — Thu, 31 Jul 2025 00:00:00 +0300

The Cajal subtype of chronic slow‑transit constipation (CSTC) is associated with Cajal cell deficienсy and is considered the most resistant to conservative therapy. Its diagnosis requires histological analysis of all layers of the intestinal wall, which involves invasiveness and carries the risk of complications. Therefore, the clinical phenotype of this subtype remains insufficiently studied.

Objective – to evaluate the clinical‑anamnestic characteristics and quality of life in patients with the Cajal subtype of chronic slow‑transit constipation following colectomy.

Materials and methods. Over the past 12 years, the Cajal histological subtype of CSTC was diagnosed in 21 patients after colectomy (group O). The comparison group included 70 patients of similar age and sex who did not exhibit signs of CSTC (group R). The study groups did not differ significantly regarding gender, mean age, or body mass index. Clinical‑anamnestic data and quality of life were assessed using the PAC‑QOL scale in both groups.

Results. Women predominated in both groups: 20 (95.2%) in the main group O and 65 (92.9%) in group R. The mean age was 33.9±8.7 years in group O, compared to 41.5 years in group R. The clinical phenotype of patients with the Cajal subtype who required surgical treatment was characterized by early disease onset at a young age (8.67±5.08 years), a high mean disease duration at presentation (25.24±11.18 years; range 3 – 51), and genetic predisposition, with a positive family history in first‑degree relatives in 50.5% of cases. These patients exhibited prolonged intervals between bowel movements (mean 12.2±4.3 days) and lack of response to conservative therapy. Stool types 1 and 2 on the Wexner scale were observed in 71.4% and 28.6% of patients, respectively. Most patients required manual assistance during defecation (95.2%) and experienced pronounced pain syndrome (visual analog scale 2.8±1.3). Quality of life, as measured by the PAC‑QOL scale, showed a significant decline in group O compared to group R across all parameters. Physical discomfort worsened by 2.72 times (3.24±0.44 vs. 1.19±0.29); psychosocial discomfort by 2.19 times (1.84±0.58 vs. 0.84±0.18); anxiety by 2.66 times (2.05±0.24 vs. 0.77±0.24); satisfaction by 2.88 times (2.48±0.59 vs. 0.86±0.28); and the PAC‑QOL score by 2.57 times (2.24±0.25 vs. 0.87±0.12), with p<0.05 for all comparisons.

Conclusions. Our findings confirm the presence of severe clinical and functional disorders in patients with the Cajal subtype, identifying them as potential candidates for surgical treatment.

Multifactorial assessment of the effectiveness of surgical treatment for obesity

O. Y. Ioffe, P. A. Kobzar — Thu, 31 Jul 2025 00:00:00 +0300

Objective – to create a model for choosing the most effective method of surgical treatment of obesity.

Materials and methods. The study was conducted at the Department of General Surgery No 2, Bogomolets National Medical University. The study group included 53 patients who consented to the bariatric procedure. The control group consisted of 59 patients. The study group underwent bariatric interventions: laparoscopic gastric bypass (37.7%), laparoscopic sleeve gastrectomy (32.2%), and 30.1% underwent the installation of an intragastric balloon, followed by gastric bypass and outcome assessment after 12 months. The control group received conservative treatment for obesity. All patients underwent routine general clinical examinations, genotyping via the Fast Real‑Time PCR System in TaqMan medium, and stool analysis using polymerase chain reaction to determine the parameters of the intestinal microbiome.

Results. Statistical data processing showed that the chance of achieving an optimal outcome is highest in patients with a detected SNP MC4R, an unsatisfactory initial intestinal microbiota pattern, and an extensive family history of obesity, as well as those who underwent laparoscopic gastric bypass.

Conclusions. Laparoscopic gastric bypass is the preferred surgical technique for obesity treatment, yielding an optimal outcome. The presence of an unsatisfactory initial intestinal microbiota pattern, the detection of SNP MC4R polymorphism, and a family history of obesity influence the effectiveness of surgical treatment. The chance of achieving an optimal outcome is 3.6 times higher in patients with a detected SNP MC4R polymorphism.

To the 100th anniversary of Ivan Tanasienko: in memory of a teacher, scientist, and surgeon

Y. P. Tsyura, M. S. Kryvopustov — Thu, 31 Jul 2025 00:00:00 +0300

The article commemorates the 100th anniversary of the birth of Ivan Denisovich Tanasienko (1925—1998), an outstanding Ukrainian surgeon, teacher, scientist, and medical education organizer. The article highlights the key stages of his life, professional development, and scientific activity. I. D. Tanasienko began his career in the post‑war period as a doctor at a peripheral hospital and rose to the rank of professor at the Kyiv Medical Institute, dean of the faculty, and head of the Department of Surgery. His scientific interests encompassed a wide range of issues related to abdominal, vascular, endocrine, and emergency surgery. He was among the first in Ukraine to adopt contemporary methods of diagnosing and treating obstructive jaundice and diseases of the stomach, biliary tract, and pancreas. He authored over 100 scientific papers, spearheaded clinical innovations, and supervised 16 candidate’s and 2 doctoral theses. Ivan Denisovich, a remarkable lecturer and mentor, influenced students’ knowledge as well as their perspective, instilling strong ethical standards in medicine. His contributions to medicine were recognized with the State Prize of Ukraine. The bright memory of I. D. Tanasienko lives on in the hearts of his students, colleagues, and grateful patients.