I. V. Rusanov

High-grade renal trauma (AAST IV and V) represents a significant challenge for surgeon in both civilian and military settings. Renal pelvic disruption with complete ureteral transection is uncommon and technically challenging for kidney repair, although an organ-preserving approach is possible in such cases to preserve renal function. Aim. The aim of this report is to present a case of successful kidney-preserving surgical treatment of severe penetrating renal trauma (AAST IV) with ureteropelvic junction disruption in a combat environment. We highlight the feasibility of reconstructive surgery at Role 3 facilities and emphasize its value in organ preservation and long-term rehabilitation of military personnel. Materials and methods. We report the case of a military service member who was admitted with stable hemodynamic parameters but developed, within three hours, a decline in hemoglobin concentration from 13.0 g/dL to 8.9 g/dL accompanied by hemodynamic instability. An exploratory laparotomy was performed to achieve hemostasis, surgical revision, and an organ-preserving intervention. Results. The patient underwent resection of the lower pole of the right kidney with ligation of the inferior segmental vessels. Ureteral continuity was restored by end-to-end anastomosis with stenting. Postoperatively, the patient was stabilized, and renal function was preserved. Conclusions. This case illustrates the feasibility of an organ-preserving strategy in severe renal trauma (AAST IV) with ureteropelvic junction injury under combat conditions. Reconstructive procedures performed at Role 3 facilities enable kidney preservation and maintenance of urinary tract function, which is of particular importance for the long-term rehabilitation of military personnel.

Objective. To evaluate the effectiveness of laparoscopy and video-assisted thoracoscopy in the treatment of diaphragmatic injuries in patients with combined trauma who are hemodynamically stable, and to compare the results with the relevant current literature data. Materials and methods. A retrospective analysis of surgical tactics was performed in 298 hemodynamically stable patients with thoracoabdominal and abdominal injuries hospitalized in 2023–2025 who underwent minimally invasive procedures (videothoracoscopy and laparoscopy). During minimally invasive revision, diaphragmatic injuries were confirmed in 34 patients. The average time from injury to surgery was (4.5 ± 2.1) hours, and the average length of hospitalization was (5.1 ± 1.3) days. Results. Computed tomography was not sufficiently sensitive, as 11 (32.4%) diaphragmatic injuries were confirmed only during endoscopic cavity revision. Left-sided diaphragmatic defects more often required laparoscopy, while right-sided defects were mainly treated with videothoracoscopy. Minimally invasive intervention in the abdominal cavity allowed us to identify a wide range of injuries to its internal organs and restore them, including the diaphragm. In all thoracoscopic interventions, damaged lungs were repaired, hemothorax was removed, bleeding was stopped, and fragments were removed from the liver, the abdominal cavity was revised, and the diaphragm was sutured. No diaphragmatic suture failures were recorded during the observation period. Conclusions. Minimally invasive approaches provide reliable diagnosis and effective treatment of diaphragmatic injuries in combat trauma in hemodynamically stable patients. The choice of access largely depends on the side of the injury (odds ratio 7.48, p=0.031). Laparoscopy may be the method of choice for left-sided diaphragmatic injuries associated with intra-abdominal trauma. Videothoracoscopy provides better access for right-sided diaphragmatic injuries combined with blind liver damage, especially if reconstructive interventions are required for concomitant intrathoracic injuries and hemostasis of the posterior segments of the liver. Minimally invasive interventions should be included in treatment protocols for hemodynamically stable patients with combat trauma.

Aim. To evaluate the feasibility, indications, and outcomes of laparoscopic surgery in hemodynamically stable combat casualties with abdominal trauma during the Ukrainian War of Independence. Material and methods. A retrospective observational study included 238 hemodynamically stable patients with combat-related abdominal trauma treated at the Zaporizhzhia Military Hospital between 2022 and 2025. Medical records, operative protocols, imaging examinations (e-FAST, computed tomography), and intraoperative documentation were analyzed. Results. Laparoscopic procedures performed included diagnostic laparoscopy (n = 78), foreign body removal (n = 60), hemostasis (n = 23), diaphragmatic repair (n = 19), hollow viscus suturing (n = 15), splenectomy (n = 5), and colectomy / colostomy (n = 12). Conversion to laparotomy was required in 28 cases (11.8 %), while secondary laparotomy was needed in 5 patients due to missed bowel injuries, intra-abdominal abscess, ileus, or bleeding. The best outcomes were achieved in American Association for the Surgery of Trauma (AAST) grade I–II injuries. Advanced bowel resections were technically complex requiring further validation for routine use. Barbed suture-based closure improved safety and efficiency in diaphragmatic and hollow viscus repair. Conclusions. Laparoscopy appears to be a safe and effective option for selected hemodynamically stable patients with abdominal combat trauma. It reduces rates of unnecessary laparotomies, postoperative complications, and recovery time, facilitating faster return of soldiers to duty. Complex bowel resections require further validation before routine implementation in military trauma surgery.

Introduction: High-energy combat trauma often results in injuries to both the radial and ulnar arteries, accompanied by extensive soft tissue loss and a low probability of sufficient collateral flow. Materials and Methods: A case series of 28 male patients with acute forearm arterial injuries from combat trauma was reviewed. Surgical approaches included ligation, end-to-end anastomosis, and autologous vein grafting. Temporary shunting was employed in select cases. The clinical outcomes were assessed. Results: Among 28 cases, 26 achieved successful hand salvage. Complications included one graft thrombosis (leading to amputation) and one death. Good late outcomes were achieved in 60% of cases. Conclusions: Repair of at least one forearm artery is essential in dual injuries. Autologous vein grafting is preferred for combat trauma. Mangled Extremity Severity Score may not reliably predict amputation. Temporary shunts can be effectively utilized with appropriate adjuncts

Introduction. Thanks to the use of renal replacement therapy at the current stage of medical development, complete medical and social rehabilitation of patients with end-stage chronic renal failure is possible. The key to effective programmed hemodialysis is the formation of adequate permanent vascular access. Ensuring the optimal use and functioning of permanent vascular access is a multidisciplinary challenge. Currently, none of the known options for permanent vascular access is ideal, but a native arteriovenous fistula meets the requirements to a greater extent. Complications from vascular access for hemodialysis remain relevant for their solution today. The most common complication of vascular access is thrombosis of an arteriovenous fistula. For patients with chronic renal failure who are on programmed hemodialysis, thrombosis of vascular access is a great danger, which ultimately can lead to the impossibility of further hemodialysis and is the main reason for hospitalization and high mortality of this contingent of patients and needs an urgent solution. Clinical cases. 17 patients underwent thrombectomy from the subcutaneous "fistula". vein of the upper extremity. The age of the patients was 49.0 (44.0-61.0) years. By gender, the studied patients were distributed as follows: women - 9 (53%), men - 8 (47%). Among 17 (100%) operated patients, 12 (71%) had late thrombosis, 5 (29%) had early thrombosis of arteriovenous fistula,. Of 5 (100%) patients with early thrombosis of arteriovenous fistula, thrombectomy was effective in 2 (40%) patients (p=0.038). On the other hand, in 12 (100%) patients with late thrombosis of arteriovenous fistula, thrombectomy was successful in only 4 (33%) cases. Discussion. The cause of thrombosis of any vascular anastomosis is primarily hyperplasia of the neointima due to the proliferation of smooth muscle cells of the vascular wall. This circumstance leads to the formation of stenosis of the anastomosis, and as soon as the stenosis values become hemodynamically significant (> 50% of the lumen of the vessel), the risk of developing thrombosis increases by more than 50%. Thrombectomy alone is insufficient to restore patency of the permanent vascular access in the long term, as flow-limiting stenosis is present in more than 85% of cases. Conclusions. Neointimal hyperplasia is the main cause of progressive stenosis of arteriovenous fistula and subsequent thrombosis. Thrombectomy is indicated for thrombosis of arteriovenous fistula in the early postoperative period (up to 30 days after arteriovenous fistula formation). Thrombectomy alone is not enough to restore the patency of the permanent vascular access in the long term, and the final treatment requires its reconstruction at an early stage or the creation of a new arteriovenous fistula.

Kidney artery aneurysms are a rare phenomenon with a prevalence of 0.01%-1% in the general population. Although historical series describe rupture rates of 14% to 30% with a mortality rate of 80%, the natural history of kidney artery aneurysms is currently characterized by a low risk of rupture and a slow to nonexistent growth rate. Criteria for repair have been controversial for decades and currently include aneurysm size > 2 cm, female sex, and symptoms such as drug-refractory hypertension, pain, and hematuria. In this article, we report a successful kidney autotransplantation for multiple renal artery aneurysms (8 to 9 mm) in a 37-year-old woman who had suffered from arterial hypertension for 19 years. The clinical case described demonstrates the efficacy of surgical treatment of renal artery aneurysms with malignant hypertension.

Мета. Оцінити ефективність хірургічного лікування пацієнтів з первинним гіперальдостеронізмом (ПГА). Матеріали і методи. За період з 2014 по лютий 2018 р. в клініці госпітальної хірургії Запорізького державного медичного університету у 46 пацієнтів діагностували ПГА, оперативне лікування проведено 23 пацієнтам, серед них 15 (65%) жінок і 8 (35%) чоловіків. Середній вік пацієнтів становив (52,3 ± 9,5) року. За даними комп’ютерної (КТ) та магнітно-резонансної ( МРТ) томографії правобічна локалізація аденом надниркових залоз встановлена у 10 (43,5%) пацієнтів, лівобічна - у 7 (30,4%), двобічна - у 6 (26,1%). Розмір об’ємних утворень надниркових залоз становив (18,3 ± 6,7) мм. Діагностику проводили згідно з Клінічними практичними рекомендаціями з діагностики та лікування первинного гіперальдостеронізму (Clinical Practical Guideline - The Management of Primary Aldosteronism; 2008, 2016). Оперативне лікування проводили з використанням ендоскопічних методів. Лапароскопічну адреналектомію виконали 19 (82,6%) пацієнтам, лапароскопічну резекцію надниркової залози - 4 (17,4%). Результати оперативного лікування оцінювали згідно зі стандартними та клініко-біохімічними критеріями PASO (Primary Aldosteronism Surgical Outcomes). Результати. Тривалість операцій становила в середньому 150 (120 - 200) хв, строки лікування пацієнтів у стаціонарі - (9 ± 2,1) доби. До конверсій не вдавалися, післяопераційних ускладнень не було. Ніхто з пацієнтів не помер. Порівняльний аналіз результатів оперативного лікування показав статистично достовірне зниження показників систолічного артеріального тиску (САТ), діастолічного артеріального тиску (ДАТ), концентрації альдостерону та підвищення рівня калію (p < 0,05). Кореляційний аналіз не виявив статистично достовірного зв’язку між концентрацією альдостерону та масою міокарда лівого шлуночка (ММЛШ), товщиною міжшлуночкової перегородки (ТМШП), товщиною задньої стінки лівого шлуночка (ТЗСЛШ) у пацієнтів до та після оперативного лікування. Клінічні результати хірургічного лікування пацієнтів з ПГА, оцінені за критеріями PASO та стандартними критеріями, практично схожі: повне одужання констатовано у 39,2 та 43,5% пацієнтів, часткове - у 60,8 та 56,5% пацієнтів відповідно; біохімічні результати, оцінені аналогічно, суттєво різнилися: повне одужання - 91,3 та 43,5%, часткове - 8,7 та 56,5% відповідно. Висновки. В хірургічному лікуванні пацієнтів з аденомами надниркових залоз, що супроводжуються ПГА, слід надавати перевагу лапароскопічним методам (адреналектомія, резекція). Ефективність мініінвазивних методів хірургічного лікування ПГА статистично достовірна. Клініко-біохімічні критерії PASO в оцінці результатів хірургічного лікування пацієнтів з ПГА мають перевагу перед стандартними, оскільки є комплексними. Після хірургічного лікування пацієнтів з ПГА повне біохімічне одужання настає у 91,3% пацієнтів, повне клінічне - у 39,2%, часткове біохімічне - у 8,7%, часткове клінічне - у 60,8% пацієнтів.