Grodno State
The scientific work of the 1st Department of Surgical Diseases is devoted to the development of new differentiated methods (algorithms) for diagnostics, treatment and prevention of surgical diseases that take into account individual patient characteristics in the field of: thoracic, vascular, abdominal surgery, hepatology, pancreatology, transplantology, herniology and proctology, based on the study of the details of etiopathogenesis. Studies have been conducted to study the pathogenesis and surgical treatment of patients suffering from the consequences of deep vein thrombosis of the lower extremities (post-thrombophlebitic syndrome). For the first time, X-ray phlebolymphograms were obtained, allowing us to trace the changes and relationships of venous and lymphatic vessels. It was proven that in case of occlusion and stenosis of deep veins, the main compensating system is not the superficial veins (as was previously believed), but the intramuscular venous vessels. This allowed to significantly expand the indications for surgical treatment of patients with various clinical forms of post-thrombophlebitic syndrome, as well as improve the methods of operations aimed at correcting regional phlebohemodynamics.
Multifaceted studies were performed to substantiate organ-preserving operations for ulcer disease of the duodenum and stomach with an in-depth study of the factors of aggression and protection of the stomach and duodenum in pyloroduodenal ulcers. Their dynamics in the postoperative period under conditions of continuous dynamic observation of patients was established. A method for pharmacorrection of the detected disorders was proposed. Indications for organ-preserving operations were determined depending on the stage of pyloroduodenal stenosis. An individual approach to the choice of vagotomy for uncomplicated and complicated ulcers was developed.
Studies were conducted on surgery of the aorta and main branches. The pathophysiological aspects of development of different stages of ischemic syndrome in atherosclerotic occlusive-stenotic lesion of lower extremity arteries have been studied. The concept of reperfusion-reoxygenation syndrome in reconstructive arterial surgery of the femoral-tibial segment has been substantiated. Methods for its diagnostics and prevention have been proposed. New data have been obtained on the patterns of formation of the amino acid pool of platelets, the fund of biogenic amines, the spectrum of plasma lipids in critical ischemia of the lower extremities of atherosclerotic genesis. A new method of pharmacotherapy in the pre- and postoperative periods of treatment of decompensated leg ischemia has been developed. A variant of revascularizing reconstructive surgery in the aortoiliac-femoral vascular segment has been patented. The problem of portal hypertension and its complications has been studied. A method of local hemostasis for the treatment of bleeding from varicose veins of the esophagus and stomach has been developed, highly informative prognostic models of the risk of recurrent bleeding from them after endoscopic sclerotherapy and laparocentesis have been calculated. Highly effective methods of open and laparoscopic esophagogastric devascularization, transjugular portosystemic shunting have been proposed. Photodynamic correction of liver parenchyma regeneration has been experimentally substantiated. Various aspects of pathogenesis, clinical presentation, prevention and treatment of patients suffering from biliary system pathology have been studied: the role of biliary hypertension in the development of cholecystitis, cholangitis, pancreatitis, mechanical jaundice; pathobiological processes in biliary tract occlusion caused by cholangiolithiasis, stenosis of the major duodenal papilla, cicatricial changes in the extra- and intrahepatic bile ducts, stricture of biliodigestive anastomoses, the methods of bile duct drainage in benign and malignant jaundice, including pathological processes in the porta hepatis area, were improved. A surgical treatment strategy was developed for patients with prolonged mechanical jaundice complicated by moderate to severe liver failure. It was proven that laparoscopic biliary decompression as a preparation for the main operation leads to an improvement in some liver function indices, while the reactions of intermediate amino acid metabolism are restored to a lesser extent. To assess the severity of pathological processes in the liver that arise in mechanical jaundice, a study of the amino acid pool of blood plasma and bile was proposed, a scheme for pharmacocorrection of amino acid metabolism was developed. Changes in the organs of the hepatobiliary system in the early and late postoperative periods were studied using various methods of choledochotomy completion: "blind" precision suture of the common bile duct, transpapillary drainage with hidden drainage and external drainage. A method for drainage of the biliary tract after surgical interventions on the extrahepatic bile ducts was developed. New experimental models of acute cholangitis were proposed. Indicators in the structure of the free amino acid pool were determined, allowing one to monitor the dynamics of treatment of acute cholangitis. langitis. The safety and effectiveness of photodynamic therapy in acute cholangitis with laser endocholedocheal irradiation of the bile ducts have been proven.
The options for optimizing the treatment of patients with diseases of the mediastinum, lungs, and recurrent spontaneous pneumothorax are considered. Rational technical methods of video-assisted thoracoscopic surgical interventions with substantiation of the criteria for the optimality of endoscopic approaches have been found, a comprehensive assessment of the effectiveness of various methods of surgical treatment of patients with recurrent spontaneous pneumothorax and its complications has been carried out. A method for video-assisted thoracoscopic mechanical - coagulation pleurodesis has been developed. Complications of video-assisted thoracoscopic operations have been studied, algorithms for surgical treatment tactics have been proposed; patterns of oxygen transport function disorders and prooxidant-antioxidant balance of the blood in patients with recurrent spontaneous pneumothorax and its complications have been established, as well as the dynamics of their changes after video-assisted thoracoscopic and traditional surgical interventions. The etiopathogenetic mechanisms of polyposis and diverticulosis of the colon, hemorrhoids, and epithelial coccygeal passage were studied. A method for forming a compression intussusception of the colon was proposed. A device was designed that allows the production of cylindrical symmetry frames by air drying from collagen gel.
Research is conducted in the following areas:
1. Development and improvement of methods for videoendoscopic treatment of funnel-shaped chest deformity, esophageal hernias, achalasia of the cardia, pleural empyema, invasive diagnostics of disseminated lung lesions;
2. Establishing the influence of homocysteine, osteoprotegerin and endothelin-1 on the nature of the course of chronic ischemia of the lower extremities, immediate and long-term outcomes of reconstructive arterial and endovascular interventions in atherosclerotic and atherodiabetic occlusive-stenotic lesions of the arteries of the femoral-popliteal-tibial segment;
3. Study of the relationship between polymorphism of folate metabolism genes (methylenetetrahydrofolate reductase - MTHFR, methionine synthase reductase - MTRR, methionine synthetase - MTR), nitric oxide synthetase 3 (NOS3), endothelin-1 with variants of the course of chronic lower limb ischemia, immediate and remote results of reconstructive arterial and endovascular interventions in atherosclerotic and atherodiabetic occlusive-stenotic lesions of the infrainguinal arteries;
4. Development and substantiation of a treatment and diagnostic algorithm in patients with extreme manifestations of ischemia and arterial damage that makes it impossible to perform revascularizing surgical interventions and endovascular interventions, based, among other things, on an assessment of the effectiveness of various options for minor amputation and resection operations;
5. Study of the amino acid pool state in patients with lower extremity arterial diseases who underwent open or X-ray endovascular revascularization operations;
6. Development of a diagnostic and treatment algorithm for acute and chronic pancreatic diseases and their complications;
7. Improvement of minimally invasive surgical treatment methods for mechanical jaundice and acute pancreatitis;
8. Development and implementation into clinical practice of a photodynamic therapy method for purulent-inflammatory diseases of the hepatobiliary zone;
9. Study of the accumulation process of the "Photolon" photosensitizer in the bile duct wall, administered endocholedocheally, and its spread through the biliary system with a justification for the advisability of photodynamic therapy for acute cholangitis, based on the state of the amino acid pool of blood plasma;
10. Analysis of the effectiveness of kidney transplantation with an assessment of early and late postoperative results, identification of factors that have a statistically significant impact on them, determination of the diagnostic and prognostic value of the identified factors in terms of the development of post-transplant complications;
11. Development of pathogenetically substantiated minimally invasive methods for the treatment of portal hypertension;
12. Development and implementation in clinical practice of new methods for the diagnosis and surgical treatment of postoperative ventral hernias;
13. Study of the relationship between the most important exogenous and endogenous factors with macroscopic and histological features of colon polyps, in dynamics, and, based on the results obtained, development of a differentiated diagnostic, therapeutic and prognostic algorithm for patient management;
14. Establishment of macroscopic and microscopic features of pilonidal cysts (both in the primary and recurrent course of the disease) and healing of postoperative wounds using various methods of their surgical treatment with the study of regenerative processes in the wound with the intraoperative use of directed polarized light as a component of surgical treatment of iliac cysts;
15. Development and implementation of methods for preoperative sanitation of epithelial ducts and cysts.
Dissertation research of the department:
For the degree of candidate of medical sciences:
• 1966 - "Changes in the vascular system of the leg and bone formation after some surgical interventions for pseudoarthrosis of the tibia", N.I. Zhandarov.
For the period 1969-1973:
• "Treatment of Dupuytren's fracture", K.N. Borisovich,
• "Lumbar discoses and their treatment", E.P. Svito,
• "Physiological foundations of therapeutic exercise", G.E. Gaidashev, "Plastic surgery of skull bone defects", A.S. Kurets,
• 1973 "Surgical treatment of peptic ulcer disease", I.K. Koyalo,
• 1973 "Surgical treatment of oncopathology of the gastrointestinal tract, I.R. Podnevich,
• 1982 "The role of the method of surgery, vascular and nervous factors in the development of compensatory-adaptive and pathological reactions of the body during distal gastrectomy", M.A. Mozheiko
• 1983 "Clinical and experimental evaluation of the effectiveness of lipase inhibition in the treatment of acute pancreatitis", P.V. Garelik,
• 1986 - "Experimental effect of retabolil on regenerative and metabolic processes in the body during gastrectomy", K.N. Uglyanitsa,
• 1987 – “Modeling and morphofunctional assessment of internal drainage of false cysts of the pancreas”, K.N.Zhandarov,
• 1990 – “Factors of “aggression” and “protection” of the stomach and duodenum in pyloroduodenal ulcers before and after selective proximal vagotomy”, N.N.Ioskevich,
• 1993 – “Functional state of the liver and its correction with “vamin” in patients with inflammatory diseases of the gallbladder”, K.A.Fomin,
• 1994 – “Targeted correction of amino acid imbalance at the stages of surgical treatment of extrahepatic cholestasis”, N.D.Maslakova,
• 1997 – “Critical ischemia of the lower extremities (correction of regional blood flow and metabolic disorders)”, V.P. Vasilevsky,
• 2000 - "The state of the lipid transport system in surgical treatment of patients with gastric ulcer and duodenal ulcer", A. Shauki,
• 2007 - "Videothoracoscopic surgery of recurrent spontaneous pneumothorax and its complications", A.A. Sushko
• 2011 - "Surgical methods for completing choledochotomy in the treatment of choledocholithiasis", K.S. Belyuk
• 2012 - "Results of treatment of acute destructive pancreatitis and parapancreatitis with local use of photodynamic therapy", A.L. Ushkevich
• 2022 - "Photodynamic therapy of acute cholangitis (experimental study)", R.S. Shilo
• 2022 - "Retrograde eversion-loop endarterectomy and correction of reperfusion-reoxygenation syndrome in chronic atherosclerotic occlusion of the superficial femoral artery", Zasimovich V.N.
For the degree of Doctor of Medical Sciences:
• For the period 1969-1973 - "Surgical aspects of venous insufficiency of the lower extremities" V.I. Savitsky,
• 1978 "Features of manifestations and treatment of chronic pancreatitis in combination with diseases contributing to its development", N.I. Zhandarov,
• 1991 – “Ways to improve the efficiency of surgical treatment of patients with various forms of cholestasis”, P.V. Garelik,
• 2004 – “Complex treatment of ischemic and reperfusion-reoxygenation syndromes in atherosclerotic lesions of the arteries of the femoral-popliteal-tibial segment”, N.N. Ioskevich.
• 2022 – “Improving the efficiency of minimally invasive surgical methods for the treatment and prevention of complications of portal hypertension in patients with liver cirrhosis”, Mogilevets E.V.
The following textbooks have been published with the stamp of the Ministry of Education of the Republic of Belarus:
"Clinical Surgery", "Practical Guide to Clinical Surgery (Diseases of the Abdominal Cavity and Peritoneum)", "Practical Guide to Clinical Surgery (Diseases of the Chest Organs, Blood Vessels, Spleen and Endocrine Glands)"; "First Aid" manual, "Surgical Diseases" (study guide).
for students of the Faculty of Medicine and the Faculty of Foreign Students with Russian as the Language of Instruction, 2018; Current Sections of Clinical Surgery: a manual for students of higher education institutions studying in the specialty 1-79 01 01 "General Medicine": in 2 volumes. Vol. 1. 2021.; Current Sections of Clinical Surgery. In two volumes. Volume 2: manual for students of higher education institutions studying in the specialty 1-79 01 01 "General Medicine" 2022; Challenging issues in clinical surgery manual for students of the Faculty of Medicine (specialty 1-79 01 01 "Medical care"), 2021.
In addition, 5 textbooks, 9 collections of scientific papers, 19 instructions for use approved by the Ministry of Health of the Republic of Belarus, more than 50 methodological recommendations for doctors and students; 95 patents were received, 555 rationalization proposals were implemented, more than 1400 printed works were published; 21 conferences were held, 8 of which were with international participation. Meetings of the problem commission on surgical gastroenterology of the USSR Ministry of Health, the congress of surgeons of the Republic of Belarus, international and thematic conferences, plenary sessions of the Board of the scientific and practical society of Belarusian surgeons with the publication of works, clinical and educational cycles for surgeons of the city and districts were held.
Currently, the department staff is conducting research work on the topic of "Development, improvement, personalization of minimally invasive, organ-preserving and high-tech methods of treating surgical diseases." The purpose of this study is to improve the results of diagnosis and treatment of patients with surgical pathology.