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> <table style="width: 600px;"> <tbody> <tr> <td valign="top" width="136px"><br /><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, <br />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 (<a href="" target="_blank" rel="noopener"></a>), VIT-A-POL LLC (<a href="" target="_blank" rel="noopener"></a>)</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 (<a href="" target="_blank" rel="noopener"></a>)</p> <p style="margin-top: .3em;"><strong>Languages:</strong> English, abstracts in Ukrainian</p> <p style="margin-top: .3em;"><strong>Editorial policy:</strong> open access to published texts, posting of articles under the terms of the Creative Commons Attribution-NoDerivatives 4.0 International license (CC BY-ND 4.0) (<a href=""></a>)<br /><img src="" alt="" width="65" height="20" /></p> <p><strong>The journal is registered as a professional edition of scientific research in the field of medicine </strong>and approved as a «B» list journal by the Ministry of Education and Science of Ukraine Order of the Ministry of Education and Science of Ukraine No 1166 as of December 23, 2022. Results of the dissertation works for obtaining the scientific degrees of doctor of sciences, candidate of sciences and Doctor of Philosophy can be published in the journal</p> <p><strong>Scientific profile:</strong> medicine (surgery, oncology, pediatric surgery, transplantology and artificial organs, anesthesiology and intensive care, immunology)</p> <p><strong>Indexed in</strong> Index Copernicus, CrossRef, Vernadsky National Library of Ukraine, Google Scholar, OUCI, Scilit, WorldCat</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 />A Digital Object Identifier (DOI)-CrossRef is assigned to 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)) Wed, 15 Nov 2023 00:00:00 +0200 OJS 60 Prevention strategies for reducing the incidence of postoperative pancreatic fistulas in patients following pancreatoduodenectomy <p><strong>Objective</strong> —&nbsp; to design and implement a&nbsp;preventive approach aimed at reducing the incidence of postoperative pancreatic fistulas and other complications following pancreatoduodenectomy in patients diagnosed with cancer of the pancreatic head and periampullary region.</p> <p><strong>Materials and methods.</strong> The present study involved the analysis of treatment outcomes for a&nbsp;cohort of 370 patients diagnosed with cancer of the pancreatic head and periampullary region who underwent pancreatoduodenectomy during the years 2015—2021. Between November 2018 and December 2021, a&nbsp;total of 141 patients were operated on using our modified pancreatic fistula risk score, an evaluation of preoperative sarcopenia status, and our risk mitigation strategies aimed at minimising postoperative complications. These patients made up the main group. The comparison group included a&nbsp;total of 229 patients. The surgical procedures were conducted between January 2015 and October 2018, employing generally accepted methods. However, the risk evaluation of potential pancreatic fistulas, the presence of sarcopenia, and the implementation of suggested prevention strategies were not taken into account.</p> <p><strong>Results.</strong> The incidence of postoperative complications was significantly higher in the comparison group, with complications occurring in 94&nbsp;(41.0%) patients, while in the main group, complications occurred in 43&nbsp;(30.5%) patients (χ<sup>2</sup>=4.1; p=0.04). In the main group, a&nbsp;total of 16&nbsp;(11.3%) patients experienced a&nbsp;clinically relevant grade B&nbsp;postoperative pancreatic fistula, which was significantly lower than in the comparison group, where the grade B&nbsp;or grade C&nbsp;fistula occurred in 64&nbsp;(27.9%) patients (χ<sup>2</sup>=14.2; p=0.0002). In the main group, 2 patients died; the mortality rate was 1.4%. In the comparison group, 5 patients died, and the mortality rate was 2.2%. This rate was shown to be higher (χ<sup>2</sup>=0.27; p=0.6) when compared to the main group.</p> <p><strong>Conclusions.</strong> The implemented approach demonstrated a&nbsp;substantial reduction in the incidence of postoperative pancreatic fistulas from 27.9% to 11.3%, the number of postoperative complications from 41.0% to 30.5%, and mortality from 2.2% to 1.4%.</p> <p>&nbsp;</p> V. M. Kopchak, L. O. Pererva, V. O. Kropelnytskyi, V. V. Khanenko, P. A. Azadov, Z. Y. Holobor Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Histological changes in the colon wall in adult patients with chronic slow-transit constipation <p>The prevalence of chronic constipation in the population ranges from 3% to 27%. Women, senile people, and people of low socio‑economic status are in this risk group more often. Many histological studies of the intestinal wall were performed in order to find the causes of slow‑transit constipation [6, 4]. The different pathological changes, including myopathies, neuropathy, and pathology of the interstitial cells of Cajal, were established. The specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation, as presented in the London classification, is currently unknown.</p> <p><strong>Objective</strong> — to determine the specific distribution of the types of histological changes in the colon wall in patients with slow‑transit constipation unresponsive to conservative treatment.</p> <p><strong>Materials and methods.</strong> A&nbsp;pathomorphological comparative case‑control study was performed. The main group included 105 patients who underwent colectomy as a&nbsp;treatment for chronic slow‑transit constipation in the period 2011—2023. The surgical intervention was indicated for patients with chronic slow‑transit constipation, resistance to conservative treatment, and a&nbsp;notable decline in quality of life. The comparison group included 27 deceased persons who did not experience constipation during their lifetime. The patient exclusion criteria were Hirschsprung’s disease, proctogenic constipation (dysfunction of the rectum and pelvic floor), medication‑associated constipation, as well as mental disorders. The histological and immunological examinations of samples were carried out in both groups, in the comparison group&nbsp;— appendix, ileum, cecum, colon and sigmoid colon.</p> <p><strong>Results.</strong> Four main morphological phenotypes of the colon wall structure elements in patients with chronic slow‑transit constipation were identified according to the research data: 1) histologically intact type, 2) myopathic type, 3) Cajal type, 4) neuropathic. A&nbsp;combination of different types of histological changes was also registered, but one of them usually dominated.</p> <p><strong>Conclusions.</strong> Four main types of histological changes in the intestinal wall were found in patients with chronic slow‑transit constipation resistant to conservative treatment: myopathic changes (56.2%), Cajal cell pathology (19%), neuropathic changes (19%), and a&nbsp;histologically intact variant (5.8%). The myopathic type is characterised by the heterogeneity of morphological manifestations, which can be referred to as dystrophic changes (dystrophic subtype 79.7%) and inflammatory changes (inflammatory subtype 20.3%), p=0.001.</p> <p>&nbsp;</p> I. M. Leshchyshyn, P. L. Byk, M. M. Plodienko, L. Y. Markulan, O. I. Okhots’ka, N. S. Martyniuk, K. M. Dmytriieva Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Comparative assessment of clinical and endoscopic semiotics of hiatal hernias <p>A hiatal hernia (HH) of type III combines the anatomical characteristics of HH types I&nbsp;and II. The manifestations of type III HHs are diverse, and they can originate from either type I&nbsp;or type II, but so far, there is no certainty regarding the correlation between the clinical and endoscopic manifestations of HH type III and its origin.</p> <p><strong>Objective</strong> —&nbsp; Based on the analysis of clinical and endoscopic manifestations of type III HH, justify the diversity of their characteristics depending on whether they originate from type I&nbsp;or type II HH.</p> <p><strong>Materials and methods.</strong> The study included 126 patients with HH, including 87 type III hernias and 39 type I&nbsp;hernias, who underwent elective laparoscopic hernioplasty. The study consisted of several steps. In the first step, an assessment of the results of endoscopic examination in patients with type III HH was conducted to determine the diversity of the obtained data and the feasibility of dividing patients into subgroups using a&nbsp;two‑stage cluster analysis. In the second step, the subgroups obtained through cluster analysis were compared between themselves and with the patients with type I&nbsp;HH to determine the similarities or differences in endoscopic findings and clinical symptoms.</p> <p><strong>Results.</strong> Cluster analysis identified two clusters of indicators with a&nbsp;strong degree of association and differentiation. The main factor in the differentiation into clusters was the relationship between the gastroesophageal junction (GEJ) and the upper border of the HS (hernia sac) in an inversion. Based on this criterion, type III HH can be divided into two subgroups: type IIIA, where the GEJ is located proximally or at the same level as the highest point of the HS, and type IIIB, where the GEJ is located distally to the highest point of the HS. The occurrence of most endoscopic symptoms of HH in subgroup IIIA, in contrast to IIIB, did not significantly differ from type I&nbsp;HH, except for the shorter length of the esophagus and the greater axial length of the hernia. Additionally, patients with the IIIA HH subtype were almost indistinguishable from those with type I&nbsp;HH in terms of clinical characteristics, except for a&nbsp;higher average age and the occurrence of dyspnea. In subtype IIIB, compared to type I, symptoms related to gastroesophageal reflux were significantly less frequent, while symptoms indicative of impaired food evacuation were more frequent. The observed similarity between the endoscopic and clinical manifestations of type I&nbsp;and subtype IIIA HH suggests a&nbsp;common origin for these conditions. On the other hand, subtype IIIB, which differs in endoscopic and clinical indicators from type I&nbsp;and subtype IIIA HH, is evidently the result of the progression of type II HH.</p> <p><strong>Conclusions.</strong> Patients with type III HH exhibit significant diversity in clinical and endoscopic manifestations, which is attributed to the different origins of the HH (from type I&nbsp;or type II). An endoscopic feature indicating the hernia’s origin is the position of the GEJ relative to the highest point of the HS: below it corresponds to type II HH (62.1%), while at or above it corresponds to type I&nbsp;HH (37.9%).</p> <p>&nbsp;</p> T. A. Tarasov, L. Y. Markulan Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Surgical treatment of patients with postoperative perianal scar deformities and concurrent rectal fistulas <p>Perianal scar deformity is referred to as a scar or deformity in the perianal area, with or without extension to the anal canal. It frequently occurs after surgical treatment for acute purulent necrotic diseases and is associated with the formation of fistulas in the scar.</p> <p><strong>Objective</strong> — to evaluate the experience of the proctology department in the treatment of postoperative perianal scar deformities and concurrent rectal fistulas using one‑stage combined plastic surgery.</p> <p><strong>Materials and methods.</strong> A prospective, non‑randomized study was carried out at the proctology department of the Kyiv City Clinical Hospital No. 18 to evaluate the treatment outcomes for postoperative perianal scar deformities and concurrent fistulas in the scar using one‑stage combined plastic surgery. A total of 34 patients were treated from January 2021 to February 2023, with an average age of 41.85±7.81 years. All patients had a history of surgical treatment of purulent‑necrotic perineal diseases. The observation period ranged from 1 to 6 months. Preoperative and postoperative data were collected to analyze the duration of surgery, the incidence of complications, the duration of hospitalization and rehabilitation.</p> <p><strong>Results.</strong> All 34 patients underwent one‑stage combined plastic surgery, which included a combination of anoplasty or sphincteroplasty and flap plastic surgery. The size of the scar deformity was important when choosing a wound closure method, as 3 (8.82%) patients had a small lesion (up to 2 cm<sup>2</sup>), 20 (58.82%) had a moderate lesion (from 2 to 6 cm<sup>2</sup>), and 11 (32.36%) had a widespread lesion of the perianal area (more than 6 cm<sup>2</sup>). The type of rectal fistula was also taken into account: a simple fistula was observed in 26 (76.47%) patients, and a complex fistula in 8 (23.53%). The average duration of the operation was 90.41±13.48 min, and the patient’s hospitalization period was 5.88±1.41 days. Postoperative complications were observed in 3 patients (8.82%).</p> <p><strong>Conclusions.</strong> Our findings demonstrate that, in the majority of patients, a single‑stage excision of postoperative perianal scar deformities and concurrent fistulas combined with skin grafting allows for the preservation of normal anal function and satisfactory cosmetic and functional outcomes.</p> <p> </p> M. V. Aksan Copyright (c) 2023 Author Fri, 17 Nov 2023 00:00:00 +0200 Multifocality as an adverse histopathological factor in papillary thyroid carcinoma <p>Papillary thyroid carcinoma (PTC) is characterized by various clinical and pathomorphological features, such as metastases to the locoregional lymph nodes and radioiodine resistance. It could also be diagnosed as a microcarcinoma coexisting with other benign thyroid pathologies or as multifocal growth. Of these, multifocality in PTC is considered an unfavourable pathomorphological feature. However, the research findings are controversial.</p> <p><strong>Objective</strong> — to investigate and evaluate the clinical and pathohistological features of multifocal PTC (mPTC) in comparison with unifocal (single nodule) PTC.</p> <p><strong>Materials and methods.</strong> Among the patients who underwent operative treatment at the clinical bases of the Department of Surgery, Institute of Biology, and Medicine at Taras Shevchenko National University of Kyiv, 91 were diagnosed with PTC and were included in the study.</p> <p><strong>Results.</strong> Out of the 91 patients, 31 (34%) had mPTC and 60 (66%) had PTC. Bilateral mPTC was diagnosed in 23 (74%) patients, which is in line with other studies. It is also worth mentioning, that 5 (16%) patients were diagnosed with multifocal growth only at the stage of histopathology section, without preoperative or intraoperative evidence of multifocality. A significantly higher frequency of locoregional metastasis was found in the mPTC group in 17 (55%) patients as compared to 18 (30%) patients with <u>PTC</u> (p=0.025). Lateral neck dissection was performed in 13 (42%) patients with mPTC, and in 13 (22%) patients with <u>PTC</u> (р=0.0525). Frozen section pathology was performed in 17 (24 patients with mPTC, and in 4 (10%) patients with <u>PTC</u> (р &gt;0,05).</p> <p><strong>Conclusions.</strong> A higher frequency of locoregional metastasis and a higher propensity for performing a lateral neck dissection are both indicators of a higher biological aggressiveness of the carcinoma in PTC multifocal growth.</p> <p> </p> A. Dinets, M. Gorobeiko, Y. Pysmenna, A. Lovin, K. Abdalla, V. Hoperia Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Quantitative assessment of the breast implant malposition after augmentation mammaplasty <p>Slight displacement of breast implants from initial positioning is expected and inherent in submuscular augmentation mammoplasty (SAMP). However, due to various factors, displacement of implants can progress, causing discomfort, changes in the shape of the breast, and deterioration of aesthetics. The boundary between normality and pathology in the case of displacement of the mammary glands (MG) implants is currently unclear due to various reasons, including the lack of a&nbsp;quantitative measure of its assessment.</p> <p><strong>Objective</strong> — to develop a&nbsp;quantitative assessment of breast implant malposition (BIM) and to determine its one‑year frequency within a&nbsp;year after SAMP.</p> <p><strong>Materials and methods.</strong> The study included 112 women who underwent SAMP for hypomastia in the period from 2020 to 2022 at the Bogomolets National Medical University. The average age was 34.1±6.7 years, body mass index&nbsp;— 20.4±1.8 kg/m<sup>2</sup>; 78&nbsp;(69.6%) women had a&nbsp;history of pregnancy and childbirth, and 75&nbsp;(67.0%) were breastfeeding. Round prostheses with a&nbsp;smooth surface were implanted in all patients. The value of BIM was evaluated one year after SAMP according to the developed method as a&nbsp;percentage of the increase in the area of the non‑ossified area in relation to the area of the prosthesis.</p> <p><strong>Results.</strong> In all women, there was a 7.94.5% (from 1.5% to 34.5%) displacement of the implants from their initial location in all MG. Among the vectors of BIM, lower‑lateral ones prevailed — 124 (55.4%) MG compared to 53 (28.6%) upper‑lateral ones, p=0.001. Lower 18 (8.0%) and upper‑lateral at 150° — 11 (4.9%) BIM were the least common. Symmetrical matching of prosthesis movement vectors in both MGs was observed in 75 (67.0%) women; in 37 (33.0%), they were different. The same values of BIM in both MGs were observed in 54 (48.2%) women. In other cases, the values of BIM were greater in the right MG — 40 (35.7%) or in the left MG — 18 (16.1%). Cluster analysis classified the displacement of implants into 4 degrees: the first — from 1.5% to 6.4%, the second — from 6.5% to 10.4%, the third — from 10.5% to 20.0%, and the fourth &gt;20.0%.</p> <p><strong>Conclusions.</strong> Using smooth‑surfaced, round implants, the displacement of all implants from their initial site was shown to be 7.9±4.5% one year following SAMP.</p> <p>&nbsp;</p> Y. M. Susak, А. B. І. Mohammad Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Optimisation of the blood supply at the flap donor site through the application of cutaneous negative pressure <p>At present, perforator flaps are a&nbsp;very popular technique in reconstructive surgery. However, in spite of the fact that perforator flaps provide favourable aesthetic results, their use is often related to complications in the form of transplanted tissue perfusion disorders.</p> <p><strong>Objective</strong> —&nbsp; to investigate the possibility of optimising the blood supply at the flap donor site through the application of cutaneous negative pressure (NP).</p> <p><strong>Materials and methods.</strong> The study was carried out from 2019 to 2021. A&nbsp;single‑arm clinical trial consisted of 20 individuals who presented with deep wound defects requiring flap coverage. A&nbsp;dynamic thermography study was conducted to examine the chosen donor site before and after dressing with NP.</p> <p><strong>Results.</strong> The temperature measurements obtained from the two selected warm perforator points and the point in the cool area between perforators prior to the application of NP showed a&nbsp;steady downward trend in temperature. Specifically, the temperature in the cool area was observed to be lower by an average of –1.89 °С and –2.12 °С as compared to warm points. The application of local NP had an impact on trend analysis of skin temperature, which demonstrated a&nbsp;significant decrease in the differences between values seen in the cool and warm areas. This effect was already noted after the first day of the NP system application, as evidenced by the everyday data collection. The «levelling» of temperature curves was associated with temperature rises both in the cool area and at the perforator exit points.</p> <p><strong>Conclusions.</strong> The findings obtained from thermography analysis suggest that the application of NP has the potential to enhance blood circulation in the intended donor area. Therefore, it is plausible to discuss the possibility of improved microcirculation in the skin and the beneficial effect of local cutaneous NP application on the state of anastomoses between perforators.</p> <p>&nbsp;</p> P. O. Badiul, S. V. Sliesarenko, O. I. Rudenko Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Mykola Markiyanovych Volkovych: surgeon, scientist <p>The article focuses on the professional and scientific achievements of Professor Mykola Markiyanovych Volkovych, who gained recognition inside and outside the borders of Ukraine. He demonstrated an exceptional level of professionalism as a&nbsp;surgeon, being honoured as one of the founders of Kyiv’s surgical school and earning a&nbsp;distinguished reputation as a&nbsp;scientist. Additionally, he introduced the «Rules for students undergoing training in the hospital surgical clinic», which are still relevant today. He’s the author of nearly 100 works encompassing a&nbsp;wide range of issues within the fields of surgery, traumatology, orthopaedics, otorhinolaryngology, gynaecology, urology, and neurosurgery.</p> <p>&nbsp;</p> L. G. Zavernyi, Y. P. Tsiura, O. P. Stetsenko, T. V. Tarasiuk, O. V. Shulyarenko, M. S. Kryvopustov Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Management of breast implant malposition. Literature review <p>Breast augmentation mammoplasty (BAM) remains the most common surgical procedure for women. According to ISAPS data, 1685471 women underwent BAM in 2021. At the same time, there is a&nbsp;high percentage of reoperations after primary breast augmentation, including breast implant malpositions (BIM): 4.7%‑5.2% after primary BAM and approximately 10% after revision BAM. These statistics refer only to severe BIM, which causes significant changes in the shape and contour of the breast and makes it look ugly. If all degrees of BIM severity are taken into account, its incidence may be much higher. The tendency of a&nbsp;foreign body to dislocate is a&nbsp;common medical problem. Implants are no exception, especially since their fixation cannot be recognized as absolute. Therefore, BIM is, to some extent, an expected complication.</p> <p>This literature review is devoted to one of the controversial problems of aesthetic surgery: the management of breast implant malposition (BIM) after augmentation mammoplasty. The review provides a&nbsp;critical analysis of the data on the classification, etiology, pathogenesis, diagnosis of ВIM, and assessment of its severity. The methods of treatment of ВIM, including the use of own tissues and additional materials, are comprehensively covered, with an emphasis on controversial aspects. The approaches to the prevention of ВIM are outlined. According to the literature, the frequency of ВIM is not known for certain since no quantitative or even qualitative assessment of its degree has been developed so far. This also limits the ability to compare the results of different treatments for ВIM in terms of the frequency and severity of malposition. Risk factors are not sufficiently assessed, and as a&nbsp;result, there are no generally accepted algorithms for their prevention and treatment. There is a&nbsp;lack of comparative studies of implant malposition treatment methods. Most studies include different revision surgeries, different anatomical implant placement planes, different implant styles, and different follow‑up durations for postoperative patients. Because of this and the lack of standardization in research, it is unclear which procedures achieve the best results. Further research is needed on the prevention and treatment of MIMS.</p> <p>&nbsp;</p> А. B. І. Mohammad, Y. M. Susak Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Methods and pathophysiology of rewarming in case of local cold injury. Literature review <p>Nowadays, rewarming of the affected tissues is the primary method of treatment for patients with cold injuries. But the warming manipulation has its own characteristics and limitations, depending on specific circumstances. Untimely and incorrectly performed rewarming can lead to a significant increase in the level of dangerous complications, mortality, and disability. The rewarming strategy is implemented according to one of the two scenarios. If there is a risk of freezing again, the injured area is not actively rewarmed; it is just immobilized, and thermo‑insulating bandages are applied. Slow warming with body heat is also acceptable. If the frozen area can be warmed and kept warm without refreezing until the evacuation is completed, a quick warming with warm water or special heating blankets is preferable. Recommendations on the ideal water temperature significantly differ among authors and include a wide range between 37 °C and 43 °C.</p> <p>The extent of damage to the tissues becomes obvious only after thawing. The traditional classification system of local cold injuries distinguishes four degrees of frostbite. First‑degree frostbite presents with superficial damage to the skin; second‑degree frostbite involves deep skin damage; third‑degree frostbite results in full‑thickness skin damage, including the subcutaneous and surrounding tissues; and fourth‑degree frostbite causes deep necrosis of the subcutaneous structures. Depending on the extent of damage, patients may experience constant and severe pain during rewarming, so analgesics should be prescribed to relieve it. It is recommended to use topical agents (creams, gels, and ointments) to improve circulation and prevent and treat infection. Tissue necrosis with severe frostbite requires surgical treatment of wounds.</p> <p>The authors hope that the provided information will be useful to doctors‑of‑first‑ contact and in hospital conditions in order to optimize the treatment of local cold injuries.</p> <p> </p> O. V. Kravets, V. V. Yekhalov, V. V. Gorbuntsov, D. M. Stanin, D. A. Krishtafor Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Patient with multifocal pancreatic insulinoma: a rare presentation of functional pancreatic neuroendocrine neoplasm <p>Insulinoma is a&nbsp;type of neuroendocrine tumour with an incidence of 1—4 cases per million. Multiple insulinomas constitute less than 10% of all insulinomas. Surgery is the treatment of choice for insulinoma. The operation can be done with an open or laparoscopic approach, with cure rates ranging from 77% to 100%. Pancreatic resection is recommended for tumours larger than 2 cm in size, while enucleation is advised for lesions smaller than 2cm if the tumour is at least 2—3 mm away from the main pancreatic duct to prevent the formation of a&nbsp;fistula. For better intraoperative localization of lesions, bimanual palpation together with intraoperative ultrasonography (IOUS) is advised. Palpation alone has 70% sensitivity, but together with IOUS, it reaches 85—95%</p> <p>A young female patient in her late 20s with non‑specific complaints and a&nbsp;medical history of epilepsy dating back to the age of 17 underwent a&nbsp;physical examination. Blood test results indicated severe hypoglycemia, and magnetic resonance imaging (MRI) revealed an 11‑mm neoplasia in the body of the pancreas. A&nbsp;72‑hour fasting test confirmed the diagnosis of insulinoma, and the patient underwent laparoscopic surgery. IOUS was done for the precise localization of the lesion, and another tumour in the pancreatic tail was found. A&nbsp;spleen‑preserving laparoscopic distal pancreatectomy was performed. Histologic reports confirmed multifocal Grade 1 insulinoma. The postoperative course was uneventful. After 4 months of follow‑up, computed tomography (CT) was done, and there were no signs of recurrence of insulinoma, pancreatic pseudocysts, or other signs of postoperative complications. Since the operation, the patient has not had any episodes of hypoglycemia or seizures.</p> <p>The wide spectrum of symptoms, which are not specific to insulinomas, in particular seizures, can make it difficult to establish a&nbsp;correct diagnosis and can be mistaken for other psychiatric or neurologic disorders. This case clearly shows the advantages of IOUS‑guided surgery in achieving better visualization and outcomes. After enucleation of the smaller lesion without the use of IOUS, other insulinomas would be missed and left in place because they were located deeply in the parenchyma. Simple visualization and palpation would not be enough.</p> <p>&nbsp;</p> E. Bobrovs, J. Pavulans, I. Konrade, R. Laguns, H. Plaudis Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200 Application of cryogenic technologies in complicated cases of surgical treatment of colorectal cancer liver metastases. Case report <p>Surgical resection is a&nbsp;standard treatment strategy for both primary and secondary malignant liver neoplasms. Liver transplantation is considered the most effective treatment method for colorectal cancer liver metastasis. Palliative debulking liver resection is one of the optimal alternative procedures for patients ineligible for a&nbsp;liver transplant, as it improves overall survival. Resectability rates depend on the functional efficiency of the remaining portion of the liver, which can be improved by increasing the future liver remnant. The application of cryogenic technologies for the ablation of a&nbsp;residual tumour invading the intraparenchymal segments of the major hepatic vessel may have advantages in cases where it is impossible to expand the scope of the surgical intervention due to the insufficiency of the future liver remnant and/or the presence of severe concomitant pathology.</p> <p><strong>Objective</strong> — to present a&nbsp;case report of cryogenic technology application in complicated cases of surgical treatment of patients with colorectal cancer liver metastases.</p> <p><strong>Case report.</strong> The case report presents an experience of cryoablation of the metastasis tissue with invasion into the intraparenchymal portal branch of Sg III, which was revealed during the I&nbsp;stage of the split <em>in situ</em>/ligation of the portal vein (ALPPS) liver resection. Cryoablation was performed by the application method with a&nbsp;single cryocycle and spontaneous thawing. Device&nbsp;— Cryo‑Pulse (Ukraine). Cryoagent&nbsp;— liquid nitrogen (T ‑180...‑196°С). Exposure time was 3 min. The specific complications associated with cryoablation were not observed.</p> <p><strong>Conclusions.</strong> The application of cryogenic technologies for combined debulking surgical treatment of malignant focal liver lesions may be a&nbsp;safe treatment option in cases of residual tumour invasion into portal vein branches. The study is still ongoing.</p> O. I. Dronov, Y. S. Kozachuk, Y. P. Bakunets, P. P. Bakunets, F. O. Prytkov, D. Y. Yurkin Copyright (c) 2023 Authors Fri, 17 Nov 2023 00:00:00 +0200