Көрсету №4 (2024)

Bulletin of Surgery of Kazakhstan

№4 (2024)

Статьи

  • 1. Surgical treatment of atrial fibrillation using cryoablation

    Z. Nurbay, R. Tuleutayev, R. Kuanishbekova, A. Djumabekov, D. Yestayev
    4–11
    Аңдатпа

    Background. This study presents the results of a clinical trial evaluating the effectiveness of surgical treatments for atrial fibrillation in patients with rheumatic mitral valve disease. Special attention is given to the comparison of cryoablation and radiofrequency ablation, two methods used in conjunction with mitral valve surgeries. The results indicate that cryoablation, a method first used in Kazakhstan, has long-term advantages for restoring sinus rhythm and cardiac remodeling, thereby improving patients' quality of life. Materials and

    Methods. The study was conducted at the period from January 2020 to March 2024 through a retrospective analysis of data from patients with atrial fibrillation and rheumatic mitral valve disease who underwent surgical treatment using one of two methods: Cryoablation with left atrial appendage clipping (Group I) – 50 patients; Radiofrequency ablation with left atrial appendage suturing (Group II) – 50 patients.

    Results. According to the conducted research, both cryoablation and radiofrequency ablation are highly effective in restoring sinus rhythm in patients with atrial fibrillation and rheumatic mitral valve disease. Cryoablation, a procedure that was used for the first time in Kazakhstan, demonstrated significant advantages in the long-term maintenance of sinus rhythm and improvement in heart remodeling parameters, such as left atrial volume. This has enhanced the quality of life for patients. Conclusions. There is a need for the widespread implementation of innovative treatments for atrial fibrillation, such as cryoablation, as surgical procedures are more effective and patients with severe cardiovascular diseases have better outcomes.

    Кілт сөздер

    Atrial fibrillation, cryoablation, radiofrequency ablation, rheumatic mitral valve disease, sinus rhythm, surgical treatment of arrhythmias

  • 2. Stepwise application of aortic wall autoplasty

    K.N. Kuatbekov, A.E. Tugambaev, A.V. Mishin, A.M. Nurbekov
    12–18
    Аңдатпа

    This paper describes the effective management of successive early postoperative complications, using aortic wall autoplasty, VAC-system, with completion of combined sterno-osteosynthesis in one cardiac surgical patient. The paper presents a clinical case of management of postoperative complications in a 67-year-old patient after aortic valve replacement and three-vessel myocardial revascularization by applying a combined and step-by-step approach for each complication: 1. In case of surgical bleeding - formation of flap plasty of the damaged aortic wall with autopericardium by in situ fixation method; 2. In case of profuse bleeding - application of VAC-system; 3. In case of high risk of sternum divergence - its closure by preferential rheosteosynthesis with tie-fixation devices. The described methods of control, carried an individual approach and the choice of the optimal method of their application, which requires knowledge of the entire arsenal of relevant and effective ways of emergency elimination of complications. In our case, unfortunately, against the background of successful one-stage treatment of all complications, the outcome was unfavorable, due to the exhaustion of compensatory mechanisms of the body against the background of severe combined acquired cardiac pathology. Autopericardium plasty by the method of fixation on the stem created additional protection of the aortic bleeding zone, and further installation of the VAC-system successfully stopped the uncontrollable non-surgical bleeding that was festering. Clamp-buckle osteosynthesis, which we applied as a standard in reoperations, contributed to more active intensive care in intensive care with improved repair of the sternum.

    Кілт сөздер

    bleeding, vacuum system, thoracoplasty, case report, cardiac surgery

  • 3. Thrombosis of mechanical valve prosthesis: a case report

    B.A. Rakishev, A.B. Kudaibergen, U.E. Imammyrzayev, R.S. Taimanova, A.D. Temirkhanov, S.A. Kaniyev
    19–24
    Аңдатпа

    Mitral valve prosthesis thrombosis is a rare but life-threatening complication associated with mechanical heart valves. It requires timely diagnosis and prompt intervention to prevent severe morbidity and mortality. We report the case with hemoptysis, severe dyspnea, and fever, two years after mechanical mitral valve replacement with a St. Jude Medical prosthesis. Despite consistent anticoagulation therapy, recent transition from warfarin to low-molecular-weight heparin during hospitalization for pneumonia may have contributed to prosthetic thrombosis. Echocardiography revealed significant mitral valve dysfunction with a mean pressure gradient of 45 mmHg and evidence of thrombus formation. Emergency surgery confirmed total prosthetic valve thrombosis and necessitated thrombectomy and replacement with a new mechanical valve. Postoperative recovery was uneventful, with improved hemodynamics and resolution of pulmonary edema. This case highlights the complexities of managing mechanical valve thrombosis in patients with multiple risk factors, including anticoagulation changes, atrial fibrillation, and recurrent pulmonary infections. The surgical approach remains the gold standard for treatment, though emerging evidence supports the potential role of thrombolysis in select cases. In conclusion, mitral valve prosthesis thrombosis represents a significant challenge requiring multidisciplinary management and strict anticoagulation monitoring, and the importance of developing standardized protocols for early diagnosis, anticoagulation management, and surgical intervention.

    Кілт сөздер

    Dysfunction of a mechanical prosthesis, prosthetic thrombosis, pulmonary edema, anticoagulant therapy

  • 4. Combined surgery of lung echinococcosis

    B.K. Shirtayev, S.A. Kaniyev, G.N. Ismailova, N.Zh. Yerimova, D.R. Kurbanov, M.G. Aitzhanov, N.N. Rakhman
    25–33
    Аңдатпа

    Background. Pulmonary cystic echinococosis, a parasitic disease, is a health care problem in developing countries. In this study, we evaluated outcomes of patients with pulmonary hydatid disease who were treated in our department.Study was performed to compare results of surgical treatment and complications of patients with unilateral or bilateral thoracic and combined pulmonary cystic echinococosis.

    Methods. This cross-sectional analysis of a prospective study was conducted in the Department of Thoracic and Pediatric Surgery, Scientific Center of Surgery, Almaty, Kazakhstan among 598 patients with pulmonary cystic echinococosis, who had surgical treatment with various surgical methods, depending on the prevalence of echinococcosis, as follows: right lung in 357 (59.5%) patients, left lung in 243 (40.5%) patients, bilateral in 95 (15.8%) patients, and complicated echinococcosis in 317 (52.8%) patients. Length of stay per hospital stay has been decreased (p 0.0001) by video-thoracoscopicechinococcectomy with the high-energy laser treatment of cyst, than after echinococcectomy by cyst treatment with povidone-iodine. Treatment with formalin presented the longest hospital stay (p 0.0001).

    Results. Comparative analysis of patients with uncomplicated and complicated pulmonary cystic echinococosis showed a high frequency of postoperative complications associated with complicated echinococcosis (OR = 2.2, p 0.0001).

    Conclusion. Despite the success of surgical treatment of pulmonary cystic echinococosis, issues of intraoperative dissemination and safety remain, and treatment success rates can be improved. These factors require further prospective multicenter studies.

    Кілт сөздер

    pulmonary cystic echinococosis, video- assisted thorascopicechinococcectomy, bilateral echinococcosis, transmedistinal access, combined echinococcosis

  • 5. Current status of the problem ventral hernias

    K.A. VENTRAL HERNIAS Moshkal, N.T. Jainakbayev, V.M. Madyarov
    34–44
    Аңдатпа

    Background. At the current stage of surgical development, the problem of prevention of postoperative ventral hernias after abdominal surgeries remains unsolved. The research aims to identify the most effective approaches to the prevention of postoperative ventral hernias and to improve surgical treatment outcomes.

    Methods. A systematic analysis of existing publications, scientific articles, and clinical guidelines focused on the prevention and treatment of postoperative ventral hernias after abdominal surgeries will be conducted. Special attention will be paid to studies describing various surgical plastic techniques and the application of biological materials.

    Results. To systematize existing methods for the prevention and treatment of postoperative ventral hernias by analyzing their effectiveness and safety. To identify the most suitable surgical techniques and materials that reduce the risk of developing postoperative ventral hernias. To highlight the need for further research in the application of biological materials and new technologies in the prevention and treatment of postoperative ventral hernias.

    Conclusion. New technologies and materials, such as biocompatible meshes and antimicrobial sutures, have the potential to enhance treatment outcomes. However, systematic and standardized prevention and diagnostic methods are essential for equipping surgeons to mitigate postoperative ventral hernias risk. Research on collagen status, its various types in connective tissue, and new diagnostic methods will be crucial for improving patient quality of life and reducing surgical risks.

    Кілт сөздер

    Postoperative ventral hernia, prophylaxis, abdominal surgery, inguinal hernias, pathological process, matrix metalloproteinases

  • 6. Stereotactic radiosurgery using Gamma Knife for Itsenko-Cushing's disease

    M.A. Bakirzhan, M.K. Kozhemzharova, G.S. Kuanyshbaeva, Z.U. Kamitbekova, A.V. Bazarova
    45–56
    Аңдатпа

    Stereotactic Gamma Knife radiosurgery is becoming the treatment of choice for patients with Cushing's disease that cannot be cured by surgery. The chances of 5-year remission are 65-75%, and control of tumor growth reaches more than 90%. However, the development of hypopituitarism (15% to 36%) is a common side effect, and severe neurological complications are rare. Relapse of the disease occurs in 16-18% of patients, but the reasons for this are unclear. Stereotactic Gamma Knife radiosurgery is effective as second line therapy in surgically untreated patients. The purpose of the study is to evaluate the effectiveness of stereotactic gamma knife radiosurgery as an adjuvant treatment for Cushing's disease, and also to consider possible complications and undesirable effects associated with the use of Stereotactic Gamma Knife radiosurgery in the treatment of Cushing’s disease. The authors analyzed the published results of international, multicenter and retrospective cohort studies on the use of Stereotactic Gamma Knife radiosurgery in patients with. According to published data, the average time to achieve remission after Stereotactic Gamma Knife radiosurgery in patients with Cushing’s disease was 16-17 months, while remission was maintained for 10 years in 60-80% of patients. Tumor growth control was achieved in 95% of cases. Our article suggests that radiosurgery is a safe and well-tolerated procedure and can provide long-term control of hypercortisolism in the majority of patients with Cushing’s disease. However, given the likelihood of relapse after initial normalization of cortisol levels and the manifestation of hypopituitarism, long-term endocrine monitoring after radiosurgery is necessary. Ultimately, radiosurgery may be considered a reasonable primary treatment option for carefully selected patients who cannot have another treatment.

    Кілт сөздер

    Stereotactic radiosurgery with Gamma Knife, Cushing's disease, relapses, complications

  • 7. CT and MRI referral practices under mandatory social health insurance

    D. Baiguissova, A. Sadykova, M.A. Baimuratova, A.R. Ryskulova, Ye. Kalshabay, A.N. Mukhamejanova, G. Battalova, A. Kabidenov, S.A.² Kaniev
    57–65
    Аңдатпа

    Background. Modern imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), are vital for diagnosing and monitoring diseases. Despite their value, challenges include high costs, radiation risks, and limited accessibility. Effective use requires collaboration between general practitioners (GPs) and radiologists. Misguided referrals burden healthcare systems, while underuse delays diagnoses. Objective. This study assesses GPs’ awareness of CT/MRI indications, examines challenges in referrals under the mandatory social health insurance framework, and analyzes radiologists’ views on unjustified referrals.

    Methods. Two surveys were conducted: one among 108 radiologists in Almaty and Astana and another among 163 GPs in Almaty and the Almaty region. Questionnaires included closed and open-ended questions, and responses were analyzed to identify barriers and optimize diagnostic processes.

    Results. Among radiologists, 56.5% reported more than five unjustified referrals per month, with CT being the most overused modality (80.6%). Reasons included GPs’ lack of knowledge about indications (66.7%) and patient pressure (67.6%). GPs cited limited mandatory social health insurance framework quotas (29.3%) and long waiting times (19.9%) as significant barriers. Both groups emphasized the need for clear clinical guidelines, enhanced education, and better interprofessional communication.

    Conclusion: Systemic improvements in radiology services are necessary. Key recommendations include developing national clinical guidelines, educating GPs on CT/ MRI indications, and streamlining administrative processes. These measures will reduce unjustified imaging, improve resource use, and enhance patient care.

    Кілт сөздер

    radiology, CT, MRI, general practitioners, mandatory social health insurance