Aim. The aim of this article is to compare the values of measured (Q_MAX) and calculated (Q_MCLC) maximal urine flow and the values of measured (T_Q) and calculated (T_QCLC) time to reach maximal flow in a large group of individual uroflowgrams during home uroflowmetry.

Materials and Methods. We analysed 29,110 individual uroflowgrams from 719 patients with prostate adenoma, aged 50 to 73 years (mean age, 60.5 ± 8.2 years), collected between 2004 and 2024. Two algorithms were used: determination of Q_MAX as the maximum value of the calculated flow (function extremum) and calculation of the actual value of the maximum flow after computer processing to eliminate interference and the WAG-effect (Q_MCLC).

Results. The data showed the following differences between Q_MAX and Q_MCLC in the groups: 16.14 % for volumes up to 100 ml; 14.62 % for 100–200 ml; 13.75 % for 200–300 ml; 13.04 % for 300–400 ml; 14.25 % for 400–500 ml; 14.55 % for 500–600 ml; and 12.65 % for 600+ ml. For T_Q and T_QCLC values, the group differences were as follows: 3.49 % for volumes up to 100 mL; 2.27 % for 100–200 mL; 0.71 % for 200–300 mL; 0.97 % for 300–400 mL; 0.91 % for 400–500 mL; 3.51 % for 500–600 mL; and 1.51 % for 600+ mL.

Conclusion. The study demonstrated a statistically significant difference between the maximum urine flow (Q_MAX) values obtained during measurement and the maximum urine flow value, after removing interference and the WAG effect (Q_MCLS) characteristic of any recorded volumes. Therefore, the accuracy of the data obtained may differ depending on the algorithm of uroflowgram processing. No statistically significant difference was found between T_Q and T_QCLC parameters. The algorithm of uroflowgrams processing used in the Sigma and Urovest uroflowmetry hardware and software system ensures high accuracy in determining maximum flow values; Urovest, in particular, has demonstrated reliability in this regard. The average determined difference between the Q_MAX and Q_MCLC values at different volumes of urination is 14.14 %.

Aim. This study aims to determine the frequency of solitary villous adenomas by colon segment and to compare the molecular genetic features of villous adenomas with the mucosa of the indexed segment and between different colon segments, as well as to consider the characteristics of unchanged mucosa of similar colon segments.

Methods. A continuous cross-sectional retrospective study of 3,086 colonoscopy results was performed. In the study, 347 cellular specimens were analysed, including 109 villous adenomas, 101 index segment mucosa samples and 137 normal mucosa samples. Detection of miRNAs and mRNAs was conducted using real-time PCR. Somatic mutations were identified with allele-specific PCR and a hydrolysable probe.

Results. The overall frequency of villous adenomas in the structure of all detected epithelial neoplasms was 3%. The frequency of villous adenomas was predominant in the sigmoid colon, while in other segments of the colon their frequency did not differ significantly. The frequency of severe dysplasia was associated with the adenoma diameter. Gene mutations similar to changes in villous adenomas were detected in the mucosa of index segments in the rectum, sigmoid colon and descending colon. Evaluation of the relative expression of 9 miRNAs and 9 protein-coding genes associated with the development of CRC in the mucosa of index segments and similar mucosal segments without adenomas did not reveal significant differences. The medians of relative expression levels of the most relevant markers – NOX1, LGR5, S4A12, TIMP, Ki-67, and TERT genes, as well as miRNA-135b, -20a, -21, -31, and -34a – were compared between different colon sections.

Conclusion. The results suggest that inspecting and biopsying unchanged mucosa, even within the index segment, does not provide insight into the risk of developing villous adenoma.

Introduction. In response to the ongoing focus of the global surgical community on the challenges of acute pancreatitis, the assessment of peripheral blood erythrocytes is proposed as a diagnostic method.

Aim. This study aims to identify changes in the erythrocyte membrane associated with moderate-severity acute pancreatitis.

Material and methods. To conduct a prospective multicenter study, venous blood was collected from 48 people. The control group included 15 blood samples taken from clinically healthy individuals. In all samples, the erythrocyte membrane was examined by atomic force microscopy (AFM).

Results of the study. Based on AFM results, samples from 33 patients with a diagnosis of moderate-severity acute pancreatitis were divided into two groups: group 1 of 16 individuals with minimal changes in erythrocytes and group 2 of 17 individuals with more pronounced changes. AFM was used to compare erythrocytes from the control group with erythrocytes from the two patient groups with regard to length, width, height, area, and volume of the erythrocyte and, most importantly, the presence of ulcerative lesions of the membrane.

Discussion. The results of AFM revealed obvious changes in the state of the erythrocyte and its membrane, with more pronounced alterations observed in group 2 patients.

Conclusion. Erythrocyte AFM provides insight into the condition of pancreatic cells in acute pancreatitis of moderate severity. The introduction of erythrocyte AFM as a diagnostic test will enable the prediction of disease progression, allowing for timely intervention and adjustments to patient management strategies.

Aim. This study aims to examine international experience in the treatment of patients with pleural empyema and bronchopleural fistula and compare it with the authors’ findings.

Methods. A systematic search of the literature spanning the past 25 years was conducted using databases such as RSCI, PubMed, and Cochrane, aiming to facilitate studies on the clinical outcomes and pathophysiological mechanisms underlying the formation of bronchopleural fistulas in the context of pleural empyema, as well as on methods for closing such fistulas. The authors present the findings from a cohort study, both prospective and retrospective, involving 136 patients treated for pleural empyema, complicated by bronchopleural fistula, at the Davydovsky State Clinical Hospital № 23.

Results. The methods of treating bronchopleural fistulas can be divided into two groups. The first group involves closing the fistula opening (suturing of the bronchial stump, reamputation and bronchial occlusion). The second group includes operations aimed at replacing the volume of the residual cavity with well-supplied tissues (such as the large omentum and muscles) or reducing the volume of the pleural cavity (thoracoplasty). In the vast majority of cases, the literature describesisolated instances of bronchopleural fistula closure using fibrin glue. According to the authors’ own experience, the effectiveness of treatment with fibrin glue was 100 %, compared to 80.3 % with bronchoblocking.

Conclusion. Improving treatment methods for patients with pleural empyema complicated by bronchopleural fistula, using autologous fibrin glue as a biological stimulator of tissue repair – especially in patients who have had COVID-19-associated pneumonia – is a promising area that warrants further multicenter research.

Introduction. The work is a review article that examines the pathophysiology, diagnostics and treatment options for slow-transit constipation.

Aim. The main goal of this study is to define slow-transit constipation, describe the primary pathophysiological mechanisms involved in its development, identify key aspects of diagnosing the condition, and thoroughly examine the existing treatment methods and their clinical efficacy.

Methods. A systematic search of the literature in electronic databases PubMed, EMBASE and Cochrane covering the past 20 years was conducted. Studies on clinical outcomes and pathophysiological mechanisms of slow-transit constipation were included in this review prepared in accordance with PRISMA guidelines.

Results. It has been established that, despite the widespread use of conservative therapy for idiopathic chronic constipation, its effectiveness in treating slow-transit constipation is low. Conversely, surgical treatment shows high effectiveness in improving symptoms and quality of life. This brings  up the question about making surgical approach the method of preference in treating slow-transit constipation. Yet, aspects related to the frequency of postoperative complications and the selection of the most appropriate surgical approach remain underexplored, leaving the question of the preferred option open for further investigation.

Conclusion. Despite the limited efficacy of conservative therapy for slow-transit constipation, radical surgical treatment shows significant improvement in symptoms and quality of life, requiring further studies to optimise treatment approaches and investigate postoperative complications.

Aim. This article aims to demonstrate the feasibility of stepwise hybrid surgical treatment for large concomitant ventral hernias with domain loss in a patient with severe coexisting pathology, based on a clinical case managed by the authors.

Methods. An analysis was conducted of a stepwise hybrid – laparoscopic and open – surgical treatment in a 63-year-old patient with inguinal-scrotal and recurrent large lumbar hernias with domain loss, complicated by obesity and diabetes mellitus. To assess the risk of compartment syndrome in the patient, computed tomography was performed, revealing a hernia contents volume-to-abdominal cavity ratio index of 28 %.

Results. A stepwise hybrid surgical treatment – a combination of laparoscopy and the open method – was performed with the use of an uncovered mesh endoprosthesis with an interval of six weeks. Taking into account the high risk of incarceration at the first stage, the inguinal-scrotal hernia was corrected. At the second stage, the recurrent lumbar hernia was eliminated with the addition of the laparoscopic method by open excision of the postoperative scar flap. The hernial defect is covered with a mesh located between the peritoneum and the duplication of the muscular-aponeurotic flap. The postoperative period was uneventful. An analysis of recent literature has revealed that the issue of selecting treatment tactics remains unresolved due to the rare occurrence of this condition. Modern approaches to the treatment of lateral abdominal hernias, including minimally invasive methods – laparoscopic, robotic and hybrid – are analysed, with a focus on methods for preventing compartment syndrome. The application of the stepwise hybrid approach used in a positive outcome after 11 months of follow-up.

Conclusion. At the first stage, it is advisable to operate on a hernia with a high risk of incarceration. The main direction in the treatment of this pathology should be the minimisation of surgical trauma and the prevention of compartment syndrome.

Aim. This article aims to present the author’s experience with laparoscopic decompression of the celiac trunk in a patient diagnosed with celiac trunk compression syndrome (Dunbar syndrome).

Methods. This article presents a retrospective analysis of the treatment outcomes in eight patients who underwent surgery between January 2020 and December 2023. The diagnosis was established on the basis of complaints, CT angiography and ultrasound. In all patients, the steps of surgical intervention included access to the abdominal cavity, survey laparoscopy and placement of trocars. Afterwards, the lesser omentum was opened to gain access to the base of the legs of the esophageal opening of the diaphragm. Next, the arcuate ligament was isolated with subsequent intersection, as a result of which the contouring of the celiac trunk was determined.

Results. The average operation time was 93.72 minutes, ranging between 60 and 180 minutes; the average blood loss was 36.25 ml. The average hospital stay was 3.25 days. When assessing longterm results, five patients experienced complete recovery, three patients noted a decrease in the intensity and frequency of pain. After surgery, all patients underwent ultrasound scanning of the celiac trunk; expiratory blood flow velocity and PSV in the SN/PSV were within the reference range.

Conclusion. The study found that in most patients with this disease, the clinical presentation is characterised by complaints of nausea, vomiting, weight loss, and pain after eating or physical activity, which aligns with data from the literature. In diagnosing the disease, the methods of computed angiography and ultrasound of the celiac trunk are of greatest clinical importance. The indication for surgical treatment of Dunbar syndrome is the presence of stenosis of the celiac trunk and symptoms of chronic abdominal ischemia. The study results indicate that laparoscopic decompression of the celiac trunk with dissection of the celiac plexus is a safe and effective treatment method.