General surgery

The present-day approach to the treatment of surgical diseases (abdominal hernia, cholelithiasis, varicosity) implies the use of reasonably low-traumatic (miniinvasive), radical, esthetically beneficial treatment methods. Remarkable changes have taken place in the operative technique, this being connected not only with the introduction of a more advanced instrumentarium, but also with the change of the idea of how the various surgical diseases should be operated.

The present-day operative interventions in the abdominal hernias:

 Abdominal hernia is one of the commonest human surgical pathologies encountered during the life span by about 2-4% of the world population. At the in-patient surgical facilities, patients with variously localized abdominal hernias account for over 10% of their total number. Hernioplasty ranks second among the operations performed globally. Today hernias are treated exclusively surgically. The methods of operative interventions are divided into the pulling (using own tissue, with correction of musculoaponeurotic structures) and non-pulling (using allografts [gauzes]) methods, and a laparoscopic ventral hernioplasty. The advent of endo-video surgical equipment has made a revolution in the operative technique, and this has immediately effected the hernia treatment. The gist of operation lies in the “non-pulling” reinforcing a weak place in the abdominal wall via endoscopic implantation of a non-absorbable synthetic material, without surgical plasty of peritoneal and musculoaponeurotic structures. The use of laparoscopic hernioplasty makes it possible to reduce the recovery period, decrease the number of relapses and lower the risk of chronic pain in the operated region.

The clinic offers the following surgeries:

• Hernioautoplasty (using local tissues) of inguinal hernia
• Hernioalloplasty(using polypropylene net) of inguinal hernia
• Hernioautoplasty of umbilical hernia
• Hernioalloplasty (using polypropylene net) of umbilical hernia
• Hernioalloplasty (using polypropylene net) of postoperative ventral hernia
• Laparoscopic hernioplasty of ventral hernias

  Principal schematic diagram of the laparoscopic hernioplasy

 Present-day operative interventions in cholelithiasis:

 Cholelithiasis is one of the most widespread diseases of the hepatobiliary system. Coleliths are revealed in 10-15% of population of the developed countries. In women, the disease is encountered 2-3 times more frequent than in men.

Gallbladder removal (cholecystectomy) is one of most often performed operations. Annually, over 500 000 patient undergo operations of this kind, and at present 90% of these perations are performed laparoscopically. The popularity of laparoscopic cholecystectomy is explained by the undeniable advantages of this procedure over the open intervention: minimal postoperative pain, cosmetic effect (no large skin scars), rehabilitation at the early postoperative period (in 1-2 days, with early return of working capacity [quick recovery]), no risk of postoperative hernias. The operative goal is to remove the gallbladder in the chronic and calculous acute cholecystitis and in the gallbladder papillomas. In cholelithiasis complicated with choledocholithiasis (presence of concrements in the common bile duct), the gist of the operation is to remove the gallbladder under the general anesthesia, using laparoscopic technique and endoscopic instruments.

Laparoscopic method enables operations to be performed with minimal (1-2cm) skin incisions.

  Principal schematic diagram of laparoscopic and traditional cholecystectomy

Clinic performs the following operative interventions:

• Traditional (“open”) cholecystectomy (if there are contraindications to laparoscopic procedure).
• Laparoscopic cholecystectomy
• Cholecystectomy through a mini-approach

Present-day operative interventions in varicosity

Varicosity of lower extremities is the varicose ectasia of the leg superficial veins accompanied by the valve failure and the blood flow impairment. According to WHO data, varicosity disturbs 30% of people. The cause lies in the hereditary predisposition to this disease and civilized (sedentary) life-style.

The use of such principles of mini-invasive vein surgery as ultrasound control (preoperative duplex mapping) provides for the possibility to reveal not only anatomic specificities but also the mechanisms that have played a decisive role in the varicosis development.

Specific features of surgical technique: the use of the inversion (screw in) stripping technique recognized the most low-traumatic version of the venous trunk removal; the use of mini-phlebectomy as the most sparing and highly cosmetic technology: varicose veins are removed from the small punctures with the help special hooks.

 The clinic performs the following operative interventions:

• Venectomy of the large subcutaneous vein
• Venectomy supplemented with fascial treatment of perforans veins
• Additional treatment of collateral veins

Vermiform process (or appendix)

Vermiform process (or appendix) is a blindly-ended process of the large intestine located in the right iliac region. The appendix wall is rich with lymphatic tissue and is inclined to inflammatory reactions. Vermiform process inflammation is named appendicitis and is a commonly encountered acute surgical disease requiring operative treatment.

Open (traditional) appendectomy means the appendix removal thorough a 5-8cm long incision in the right iliac region. This method is somewhat safer that the laparoscopic appendectomy, however, the postoperative period following the open operation runs harder, and patients require longer treatment in the in-patient facility.

Laparoscopic removal means an appendix removal, using special laparoscopic technique and relevant instruments. Operation is performed through small (0.5 – 2.0cm) punctures. Usually, 3 punctures are made, although the number of punctures may vary in different patients. In some patients, chronic inflammation of the vermiform process occurs, which require the planned operation to be performed.

Clinic performs the following operative interventions:

• Appendectomy in acute appendicitis without peritonitis
• Appendectomy in an appendicitis with peritonitis
• Appendectomy in chronic appendicitis

Laparocentesis or paracentesis

 Laparocentesis or paracentesis is a puncture of the anterior abdominal wall to obtain the liquid accumulated in the abdominal cavity.

Study objectives:

Diagnostic laparocentesis is performed to reveal the reasons of liquid accumulation in the abdominal cavity (ascites). Curative laparocentesis is performed to remove the liquid and control its volume.

 Thus, a precise preoperative diagnostics, modern instrumentarium and correct understanding of a disease enable us to perform highly effective surgical interventions with good esthetical results, short rehabilitation period and high quality of patient life. On the one hand - operative radicalism and aspiration for maximal curative effect; and on the other hand - striving for minimal traumatism and high cosmetic effect: this is the only way to achieve harmony, so necessary to everybody.