The lipid profile in patients with obesity who have undergone vertical gastroplasty

The effect of vertical banded gastroplasty (VBG) on the lipid profile in obese patients is considered. The antiatherogenic effect of VBG and of the following weight loss consists in significantly decreased plasma triglycerides, increased content of high-density lipoproteins and decreased atherogenic coefficient. Patients with hypercholesterolemia have significantly lower total plasma cholesterol by the period of the body mass stabilization. The effect of VBG is compared with that of other methods of correction of dyslipidemia. The possibility to improve this effect is also discussed.     

The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.     

Surgical treatment of recurrent goiter

The authors have analyzed and generalized their 20-years experience with surgical treatment of 247 patients with recurrent goiter. Among them 48 patients had recurrent toxic goiter and 199 patients had nontoxic goiter. Postoperative complications developed in 8.3% of the patients with recurrent toxic goiter and in 6% of the patients with nontoxic goiter. The overall postoperative lethality was 1.2%. Operative treatment is recommended by the authors for recurrent toxic and nontoxic goiter, conservative treatment with radioactive iodine is thought to be expedient for a repeated recurrence. For preventing recurrences of toxic and nontoxic goiter after the first operation the administration of small does of the thyroid hormones is considered to be expedient during 1.5-2 months.     

A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.     

An approach to the right hepatic duct in treating high damage and cicatricial stricture of the bile ducts

There was proposed an operative access to the duct via the lateral end of transverse hepatic fissura, basing on the results of studying of the right hepatic duct anatomy. The method performed includes the right hepatic lobe mobilization, its fibrous capsule transsection along the transverse fissura in the direction toward right posterior sectorial duct, longitudinal transsection of the duct lateral wall along 1-2 cm with subsequent formation of laterolateral hepaticojejunoanastomosis. Method was tested in 9 patients with high damage and cicatricial stricture of biliary ducts, the result was positive.     

The surgical treatment of toxic goiter in middle-aged and elderly patients

Of 128 patients, ageing more than 60 years, polynodular toxic goiter was diagnosed in 84, diffuse toxic goiter--in 34, toxic adenoma--in 10. The nodules in thyroid gland (TG) were revealed in 94 patients, cancer--in 3. There were following indications for the operation: the lack of the thyreostatic therapy efficacy, the malignant-like nodules presence, compression of cervical and mediastinal organs. After the euthyreotic state achievement all the patients were operated on using endotracheal narcosis. Subtotal resection of TG was performed in 91 patients, thyroidectomy--in 27, hemithyroidectomy--in 10. The frequency of specific complications (n. recurrence damage, bleeding, hypoparathyroidism, the wound purulent complication) was 4.7%.     

The complications of wound healing after an operation for ventral hernia and their prevention

For abdominal hernia 982 patients were operated. The complications had occurred in 18.6% of patients due to chronic inflammation and the presence of "sleeping" infection in the hiatal gates margins. Application of the elaborated prophylaxis complex of measures had permitted to lower the frequency of the wound healing complications down to 9%.     

Radiofrequency electrostimulation of carotid sinus nerves for the treatment of bronchial asthma

Electrostimulators of synocarotid nerves (SCN) were implanted in 30 patients aged from 18 to 62 years for the treatment of bronchial asthma. The procedures of SCN stimulation (from 1 to 10 daily) were carried out with parameters of 30-100 Hz, 0.1-0.8 ms, 0.5-2.0 V. The external respiration function was examined by pneumotachometry and spirography, and cardiovascular system by the method of rheography. The attacks of apnea were effectively eliminated and prevented by electrostimulation (ES) of SCN. The frequency of the attacks 2 and 5 years after the procedures decreased 2.8 fold, and the duration of the attacks--3.5 fold. Daily consumption of antiasthmatic drugs decreased by 2.7 times. Some complications were detected: rejection of the electrostimulator (1 patient), paresis of n. hypoglottis (1), suppuration of the wound (3), abnormal mobility of the electrostimulator (1). ES of SCN can be applied in patients with complicated forms of bronchial asthma and severe drug addiction.