General Surgery

Yaroslav Yosypovych Kryzhanovskyi — the path of a doctor, scientist, and educator

Y. P. Tsyura, M. S. Kryvopustov — Sun, 31 May 2026 00:00:00 +0300

This article examines the life and professional career of Yaroslav Yosypovych Kryzhanovskyi, an eminent Ukrainian surgeon, orthopaedic traumatologist, scientist, and educator. It traces his life journey from childhood in a peasant family in the Ternopil region to his appointment as professor and head of the department at Bogomolets Kyiv Medical Institute. The article analyses his academic training, early medical practice, and organisational initiatives, with particular focus on the development of urological services and his teaching activities. Considerable attention is devoted to his scientific achievements, including the defence of his candidate and doctoral theses, introduction of new surgical methods for treating musculoskeletal injuries and diseases, and his inventive contributions. The article highlights the scientist’s impact on military field surgery, postgraduate medical education, and the training of scientific personnel. His efforts to improve the educational process, establish specialised surgical centres, and develop a scientific school are also emphasised. The article concludes by underscoring Y. Y. Kryzhanovskyi’s significant contributions to Ukrainian medicine, surgery, and medical education.

Clinical case report: management of a patient with extensive bone and soft tissue damage after a mine-blast injury

A. O. Zhernov, D. M. Sydorenko, H. H. Pipiia, I. O. Vorobei, A. O. Shelest — Sun, 31 May 2026 00:00:00 +0300

Combat-related upper extremity trauma is one of the most frequent and severe categories of injuries in contemporary armed conflicts. Such injuries often cause extensive bone and soft tissue damage, impaired blood supply, infectious complications, and reduced limb mobility. In many cases, these problems require amputation, significantly diminishing patients’ quality of life.

This report presents the clinical management of a 35-year-old patient who sustained a mine-blast injury. The injury resulted in combined chest and right upper limb trauma, including a humeral defect and extensive soft tissue damage. Treatment progressed in stages, following principles of damage-control surgery. Interventions included pleural cavity drainage, repeated surgical wound management, vacuum-assisted closure (VAC), and stabilization of bone structures. After the patient was stabilized, we performed a reconstructive procedure using a latissimus dorsi musculocutaneous flap on a vascular pedicle to close the soft tissue defect. Subsequently, the bone defect was reconstructed using a non-vascularized fibular autograft. This approach was chosen because of extensive cicatricial changes at the injury site. The comprehensive treatment facilitated limb salvage and enabled partial restoration of mobility by preserving the elbow joint and distal segment mobility.

This clinical case shows that, even in severe mine-blast upper extremity injuries with extensive tissue damage, reconstructive interventions can be an effective alternative to amputation. Success depends on individualized treatment planning, thorough infection control, and preservation of function in the distal segments of the limb.

Endovascular interventions in technically challenging cases of post traumatic aneurysms and arteriovenous fistulas of limb arteries. Clinical cases

Y. M. Susak, K. V. Humeniuk, Y. V. Nahaliuk — Sun, 31 May 2026 00:00:00 +0300

Objective – to analyze current scientific data on the role of endovascular interventions in the management of technically challenging post-traumatic pseudoaneurysms (PTPA) and arteriovenous fistulas (AVF) of major extremity vessels resulting from gunshot wounds; to define the indications, benefits, and limitations of minimally invasive methods; to justify their role within hybrid strategies in comparison with conventional open reconstructions; and to present our case series of successful clinical observations.

Materials and methods. A systematic analysis of specialized literature dedicated to major extremity vessel injuries and their delayed complications was conducted. The review covers the experience of armed conflicts spanning from World War II to modern operations in Iraq and Afghanistan. We analyzed fundamental works (DeBakey, Rich), data from the Vietnam Vascular Registry involving 558 post-traumatic lesions, as well as contemporary epidemiological and multicenter studies (White, Clouse, DuBose) that highlight outcomes of endovascular management for vascular trauma. Special attention was paid to the comparative analysis of treatment strategies in anatomically complex (junctional) zones, where open surgery is associated with high operative trauma and increased risk of iatrogenic injuries.

Results. It was established that PTPAs and AVFs account for approximately 7% of all vascular injuries within the structure of combat trauma. Open reconstruction (resection with autogenous vein grafting) remains the priority for contaminated wounds, infected PTPAs, and lesions located within flexion zones in young patients. It was found that in proximal segments not affected by infection, covered stent-graft implantation achieves a technical success rate of over 90%, thereby radically minimizing dissection volume in anatomically complex zones. Embolization is positioned as an effective method for isolating branch lesions and providing adjuvant support for stenting. The main limitations of the endovascular approach include the risk of stent fracture in highly mobile segments and insufficient fixation zones. The feasibility of hybrid strategies in chronic high-flow AVFs with pronounced venous transformation is emphasized. The presented case series confirms the efficacy of the chosen algorithms in treating the consequences of gunshot wounds in both short- and mid-term periods.

Conclusions. Endovascular technologies are not a complete alternative to open vascular surgery, but they significantly expand the tactical arsenal in the management of extremity PTPAs and AVFs, particularly in cases of anatomically unfavorable lesion localization and high operative risk. The use of covered stent-grafts and selective embolization methods, with careful patient selection, ensures high technical success and stable clinical outcomes. The implementation of hybrid strategies allows for effective individualization of treatment tactics in the most complex cases with pronounced venous transformation. The choice of intervention (open, endovascular, or hybrid) must be based on a comprehensive assessment of the lesion’s angioarchitecture, the presence of an infectious process, the biomechanical characteristics of the affected segment, and the patient’s functional demands, which rules out the use of simplified, one-size-fits-all algorithms.

Amplatzer occluder closure of postoperative bronchopleural fistula: a three-case series

Sun, 31 May 2026 00:00:00 +0300

Bronchopleural fistula (BPF) remains one of the most feared complications after major thoracic surgery because it is associated with prolonged hospitalization, empyema, respiratory failure, and substantial mortality. In selected patients, bronchoscopic closure with cardiac occlusion devices originally developed for closure of septal defects may offer a minimally invasive alternative to repeat surgery.

Case presentation. We report three patients with postoperative BPF treated with an Amplatzer occluder. Case 1 developed bronchial stump insufficiency in the setting of chronic pleural empyema years after right upper lobectomy. The placement of a bronchoscopic occluder resulted in adequate occlusion of the BPF for 3 months following the procedure. Case 2, a multimorbid patient with squamous cell carcinoma, developed an early post-lobectomy BPF. Multiple prior interventions, including re-thoracotomy and segmental endobronchial valve treatment, provided only temporary control. Subsequent occluder placement at a newly identified stump fistula achieved only transient closure, and the patient passed away later from cardiorenal multiorgan failure under palliative conditions. Case 3 developed recurrent empyema secondary to bronchial stump insufficiency after right pneumonectomy. Initial bronchoscopic placement of the occluder was technically unsuccessful because of pronounced lateral angulation of the fistula. Definitive closure was achieved using a combined video-assisted thoracoscopic surgery (VATS)-guided and bronchoscopic-assisted occluder implantation with adjunctive fibrin glue installation.

Conclusions. Amplatzer occluder placement is a feasible minimally invasive option for selected postoperative BPFs. Successful treatment depends not only on fistula size, but also on anatomy, angulation, local infection control, and the patient’s global physiological reserve. In anatomically complex fistulas with pronounced angulation, a hybrid VATS-guided and bronchoscopic-assisted approach may enable successful occluder implantation when purely bronchoscopic placement is not feasible.

Surgery-induced immune modulation: a comprehensive review

R. S. Dovhyi, T. V. Babich, T. V. Bulyhina, L. M. Skivka — Sun, 31 May 2026 00:00:00 +0300

Surgical intervention induces profound and dynamic alterations in the body’s immune reactivity. The postoperative period is typically characterized by an early hyperinflammatory response, followed by compensatory immunosuppression; however, in some cases, a maladaptive condition known as persistent inflammation, immunosuppression, and catabolism syndrome may develop. These immune disturbances are associated with an increased risk of infectious complications, impaired tissue repair, organ dysfunction, and potential tumor progression. Modulation of surgery-induced changes in immune responsiveness may represent a promising strategy for improving surgical outcomes. The aim of this review is to analyze and synthesize current literature on the mechanisms and key determinants of postoperative immunomodulation.

The review discusses the complex mechanisms underlying the initiation and progression of postoperative systemic hyperinflammation, as well as the triggers and pathways involved in compensatory anti-inflammatory response syndrome. Particular attention is given to the temporal dynamics and phase-dependent nature of postoperative immunomodulation. Key determinants shaping the intensity and trajectory of post-surgical immune responses are examined, including surgical factors such as the extent and duration of tissue injury, as well as anesthetic techniques and agents. In addition, patient-specific factors influencing postoperative immune modulation, such as age, sex, and preoperative immune status, are analyzed in detail.

Overall, the early postoperative period represents an underutilized window of therapeutic opportunity for improving surgical outcomes. However, its effective clinical exploitation requires a deeper understanding of the mechanisms underlying post-surgical immunomodulation, as well as the development and implementation of highly sensitive, dynamic biomarkers for continuous, real-time monitoring. Such advances would enable truly personalized, phase-adapted therapeutic strategies tailored to the patient’s evolving immune state.

Current perspectives on kidney transplantation in low-weight pediatric patients. Review

V. P. Zakordonets, O. Y. Ioffe — Sun, 31 May 2026 00:00:00 +0300

Kidney transplantation is the treatment of choice for children with end-stage renal disease, providing superior survival and quality of life compared to dialysis. However, transplantation in children with low body weight (≤ 20 kg) remains technically demanding and is associated with a higher risk of complications. These challenges are primarily related to donor–recipient size mismatch, limited anatomical space, and hemodynamic constraints. A narrative review of the literature was performed, focusing on surgical techniques, anatomical and hemodynamic factors, and early and late complications of kidney transplantation in low-weight pediatric recipients. Particular attention was given to the impact of size mismatch, the choice of surgical approach, and strategies for prevention and early detection of vascular complications.

Donor-recipient size mismatch was identified as a central pathophysiological factor influencing outcomes. It contributes to a complex cascade involving impaired venous outflow, graft edema, increased intrarenal pressure, and secondary reduction of arterial perfusion. Both intraperitoneal and extraperitoneal approaches are effective, with no consistent differences observed in long-term graft survival. Outcomes are primarily determined by the adequacy of graft positioning and perfusion. Vascular complications, particularly arterial and venous thrombosis, remain the leading cause of early graft loss in this population. Renal allograft compartment syndrome is a specific manifestation of mechanical and hemodynamic imbalance. Early diagnosis using Doppler ultrasonography and prompt surgical intervention are critical for graft preservation.

Kidney transplantation in children with low body weight requires an integrated surgical and perioperative strategy aimed at compensating for anatomical and hemodynamic mismatch. The success of transplantation depends on the coordinated optimization of graft positioning, vascular geometry, space creation, and postoperative monitoring, rather than on a single technical factor. A proactive, mechanism-based approach is essential to reduce complications and improve outcomes in this high-risk population.

Enhanced recovery after surgery (ERAS) protocols in inguinal hernia surgery: current state of the problem. Review

A. V. Trots, O. V. Perekhrestenko — Sun, 31 May 2026 00:00:00 +0300

Inguinal hernia remains one of the most common surgical conditions worldwide. Despite substantial advances, including the development of minimally invasive hernia repair techniques, issues related to functional treatment outcomes are still relevant, particularly the intensity of early postoperative pain, time to return to usual physical activity, quality of life, and the risk of chronic postoperative inguinal pain (CPIP). In this context, Enhanced Recovery After Surgery (ERAS), also known as accelerated postoperative recovery, represents a promising model for standardizing perioperative management in patients with inguinal hernias.

Objective – of this review was to summarize current data on the application of ERAS principles in inguinal hernia surgery, with an emphasis on preoperative, intraoperative, and postoperative components, and their potential impact on pain, functional recovery, length of hospital stay, complication rates, and patient-reported outcomes.

The review examines the role of preoperative patient education, risk stratification, correction of comorbidities, rationalization of preoperative fasting, prevention of postoperative nausea and vomiting, selection of the surgical approach and method of prosthetic material fixation, multimodal analgesia, maintenance of normothermia, individualized infusion therapy, selective antibiotic prophylaxis, early mobilization, resumption of oral nutrition, prevention of urinary retention, and thromboprophylaxis. The implementation of ERAS in inguinal hernia surgery involves adapting the general principles of enhanced recovery to address key challenges in herniology: minimizing early and chronic pain, reducing opioid exposure, accelerating functional recovery, ensuring safe early discharge, and improving patients’ quality of life. Laparoscopic techniques, such as transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs, offer advantages within the ERAS framework compared with open techniques, provided that adequate material and technical resources are available. Nevertheless, the choice of surgical treatment method should be individualized for each patient. Future efforts should now focus on establishing unified, hernia-specific ERAS protocols and prioritizing prospective studies that assess long-term treatment outcomes.

Morphological types of the external oblique abdominal muscle aponeurosis: a morphometric and histological justification

L. Y. Markulan, K. V. Halperin, S. V. Pakrishen — Sun, 31 May 2026 00:00:00 +0300

Objective – to investigate the histological and morphometric characteristics of the external oblique aponeurosis in the region associated with the linea semilunaris (the Ambivium zone).

Materials and methods. The study included 34 women aged 22 – 54 years (mean age: 36.2±7.3 years) who underwent abdominoplasty for cosmetic defects of the anterior abdominal wall. During surgery, standardized fragments of the external oblique aponeurosis were obtained from symmetrical regions adjacent to the lateral border of the rectus sheath. Histological, histochemical, and morphometric analyses were performed, including assessment of collagen bundle thickness, width of the endotenonium and peritenonium, parameters of the microcirculatory bed, and the relative areas occupied by collagen, peritenonium, and vessels. Hierarchical cluster analysis and the k-means method were applied to systematize the identified structural variants.

Results. Morphometric analysis revealed substantial variability in the structural organization of the aponeurosis: the proportion of collagen fibers ranged from 61.1% to 91.2%, the proportion of peritenonium from 7.3% to 33.9%, and the compactness coefficient from 0.64 to 0.93. Cluster analysis enabled the identification of three morphotypes: compact (35.3%), transitional (26.5%), and disorganized (38.2%). The compact morphotype was characterized by a high proportion of collagen (89.32±1.52%), minimal content of peritenonium (8.86±1.15%), and the highest compactness coefficient 0.91±0.01. In contrast, the disorganized morphotype demonstrated the lowest proportion of collagen (68.18±4.04%), the highest content of peritenonium (26.87±4.11%), a low compactness coefficient 0.72±0.05, widening of interfascicular spaces, remodeling of the vascular component, and signs of pronounced histostructural reorganization. The transitional morphotype occupied an intermediate position. All intercluster differences were statistically significant (p < 0.001).

Conclusions. Morphometric and cluster analysis of the external oblique aponeurosis revealed substantial structural variability and enabled the identification of three morphotypes–compact, transitional, and disorganized–which differed in the proportions of collagen fibers, peritenonium, vascular component, and compactness parameters. The identified morphological heterogeneity of the aponeurosis reflects different degrees of structural remodeling and may represent one of the factors contributing to variability in the outcomes of surgical correction of the anterior abdominal wall, thereby supporting the rationale for further individualization of surgical strategy.

Impact of perioperative hydrocortisone administration on the regeneration of the future liver remnant in right lobe living-related liver donors

O. Dronov, I. Kotenko — Sun, 31 May 2026 00:00:00 +0300

Liver transplantation from a living-related donor remains one of the most effective treatments for end-stage liver disease. Ensuring maximum donor safety and preventing postoperative liver failure is an absolute priority. A key factor in the favorable postoperative course in donors after right hemihepatectomy is the rapid and complete regeneration of the future liver remnant (FLR). Liver resection and unavoidable ischemia-reperfusion injury trigger a cascade of systemic inflammatory responses with a massive release of pro-inflammatory cytokines, particularly interleukin-6. While controlled inflammation is necessary to initiate the regeneration process, hyperinflammation can disrupt microcirculation and slow early parenchymal recovery. Perioperative glucocorticosteroid administration is an effective method of modulating inflammation, yet its direct impact on morphological regeneration in living donors remains insufficiently studied.

Objective – to investigate the effect of perioperative intravenous hydrocortisone on the dynamics of the regenerative capacity of the future liver remnant in living-related donors after right hemihepatectomy using computed tomography (CT) volumetry.

Materials and methods. A prospective randomized controlled trial was conducted at the Oberig Clinic from September 2023 to December 2025. The study included 100 right lobe living-related liver donors. The experimental group (Group A, n=50) received an intravenous bolus of 500 mg hydrocortisone sodium succinate 10 – 15 minutes before parenchymal transection, followed by 100 mg/day on postoperative days 1 to 5. The control group (Group B, n=50) received standard care without systemic steroids. The left liver lobe volume was assessed using multidetector CT before surgery (RLV0), on day 14 (RLV14), and on day 90 (RLV90).

Results. Preoperative RLV0 was similar between groups (440.0±96.5 mL in Group A, 448.7±94.0 mL in Group B, p=0.649). On postoperative day 14, Group A demonstrated a significantly more intensive volume increase: RLV14 reached 889.9±181.8 mL compared to 808.3±154.3 mL (p=0.017), with a regeneration index of 106.3±37.5% vs. 84.9±42.3% (p=0.009). On day 90, the difference became highly significant: RLV90 was 1097.4±203.8 mL vs. 920.6±143.8 mL (p < 0.001), with an increase of 155.1±45.7% vs. 110.4±38.0% (p < 0.001). Hydrocortisone effectively smoothes the pathological peak of inflammation and prevents massive ischemia-reperfusion injury. Preserved from excessive apoptosis, the parenchyma receives optimal conditions for full cellular division from the first days.

Conclusions. Perioperative intravenous hydrocortisone is safe and does not suppress liver recovery. Modulation of the systemic inflammatory response significantly increases the intensity of morphological regeneration of the left liver lobe, as confirmed by a significant increase in absolute volume and regeneration index in both early (p=0.009) and late (p < 0.001) postoperative periods.

One-year treatment outcomes in patients with lower extremity deep vein thrombosis

D. S. Myrhorodskyi, A. O. Burkа — Sun, 31 May 2026 00:00:00 +0300

Lower extremity deep vein thrombosis remains one of the leading causes of venous thromboembolism and is associated with the risk of pulmonary embolism, post-thrombotic syndrome, and disease recurrence. In contemporary clinical practice, direct oral anticoagulants (DOACs) are considered an alternative to traditional anticoagulant therapy using low-molecular-weight heparin and warfarin. However, the outcomes of their use in real-world clinical practice require further investigation.

Objective – to evaluate the treatment outcomes of acute deep vein thrombosis of the lower extremities in patients receiving conventional anticoagulant therapy with low-molecular-weight heparin and Warfarin, compared with those treated with direct oral anticoagulants, focusing on recanalization, recurrence of venous thromboembolism, and treatment safety in real-world clinical practice.

Materials and methods. A single-center retrospective comparative cohort study was conducted involving 217 patients with acute lower extremity deep vein thrombosis treated between 2020 and 2025. The traditional therapy group included 82 patients who received low-molecular-weight heparin followed by transition to warfarin, whereas the DOAC group included 135 patients treated with rivaroxaban, dabigatran, or apixaban. The primary endpoints were venous segment recanalization and recurrence of venous thromboembolism during the 12-month follow-up period.

Results. At 3 months after treatment initiation, complete venous segment recanalization was achieved in 18.0% of patients, partial recanalization in 71.0% of patients, while no recanalization was observed in 11.1% of patients. There was no statistically significant difference between the groups in the degree of recanalization (p=0.839). The one-year recurrence rate of venous thromboembolism was 8.8%: 7.3% in the traditional therapy group and 9.6% in the DOAC group (p=0.557). No significant difference in recurrence rates was identified among the different agents within the DOAC group. No major hemorrhagic complications or anticoagulant therapy-related deaths were recorded in this study.

Conclusions. Traditional anticoagulant therapy with low-molecular-weight heparin followed by warfarin and direct oral anticoagulants demonstrated comparable clinical efficacy in the treatment of acute lower extremity deep vein thrombosis: after 3 months, complete or partial venous segment recanalization was achieved in 89.0% of patients, with no statistically significant difference between the groups (p=0.839). The absence of major hemorrhagic complications and anticoagulant therapy-related mortality indicates a satisfactory safety profile for both traditional anticoagulant therapy and direct oral anticoagulants in the treatment of acute lower extremity deep vein thrombosis in real-world clinical practice.