History of the department
The Department of Hospital Surgery (now Surgical Disease No. 2) was organized on June 11, 1943. From the day of organization, the department has been productively training high-qualified teaching and research personnel. Along with this, the department’s staff did a great work of organizing various areas of surgery in the republic, introducing new advanced methods of surgical treatment of pathologies of the organs of the chest and abdominal cavities, mediastinum, cardiovascular system, peripheral nerves, etc. Professor Alexander EfimovichMannheim was the first head of the department (1943-1945). He made a certain contribution to the preparation of the teaching staff, the organization of medical and research work among the young staff of the department, and the organization of the surgical service as a whole.
Already at the begining of organization, the department actively sought to introduce advanced, for that time, specialized methods in surgical practice. In particular, reconstructive surgery - plasty defects of the face by Filatov flap, lung resection and pulmonectomyinsuppurative lung diseases, anterior-sternum esophagoplasty from the small intestine. At the head of these initiatives was the head of the department, Honored Scientist of the Tajik SSR, corresponding member of the Academy of Sciences of the Tajik SSR, Professor Nikolai Fedorovich Berezkin (1945-1956). In the same years, the Society of Surgeons of the Tajik SSR was also organized.
Employees of the department are considered pioneers in the problem of alloplasty for primary and postoperative hernias in the former USSR. In this direction huge clinical and experimental work was carried out during the years of the department’s leadership by N.Z. Monakov (1956-1968) - MD, professor - Honored Doctor, Honored Scientist, Corresponding Member of the Academy of Sciences of the Tajik SSR. The results of the work were summarized by the defense of a number of candidate and doctoral dissertations and monographs. In the same years the foundation was laid for the use of non-tensioning methods of hernioplasty, which are now already popular in the treatment of patients with huge especially postoperative hernias. The main material as a mesh prosthesis was a polyphiliccapron, which was prepared by the department staff themselves manually. After an experimental study, this method was successfully introduced into clinical practice and, until recently, was widely used outside the republic.
Another direction of the research work of the department was the study of the effectiveness of glucocorticoids in the prevention and treatment of postoperative adhesions of the abdominal organs, which to this day is considered relevant in surgery.
For more than 40 years (1970-2010), the Department of Hospital Surgery, Academician of the Academy of Sciences of the Republic of Tajikistan, Honored Scientist of the Tajik SSR, Laureate of the State Prize named after Abuali ibni Sino, Doctor of Medical Sciences, Professor Usmanov Negmatullo Usmanovich. This period is characterized by the formation of a specialized multidisciplinary surgical hospital with a wide range of research and clinical activities. The department and its clinical base, the Republican Scientific Center for Cardiovascular Surgery, has become one of the recognized centers of surgery not only in the Republic of Tajikistan, but also abroad.
For about 40 years, the department dealt with the problem of surgery of the lungs and mediastinal organs. In clinical practice has introduced advanced diagnostic methods, conservative and surgical treatment of diseases of the lungs and pleura, in particular with lung’s acute infectious destruction and echinococcosis. For a number of years, surgery of post-burn esophageal constrictions was considered a big urgent problem. In reconstructive surgery of the esophagus, small intestinal intrathoracic total esophagoplasty, including microsurgical transplant revascularization, was successfully introduced. In cardiac achalasia surgery, the cardiofundoplication method developed by the department according to N.U. Usmanov, is still successfully applied. Developments in the treatment of pulmonary echinococcosis, which are endemic to our region, are considered important. Along with the improvement of organ-preserving and organ-saving lung operations with this pathology, the barrier to the use of endoscopic methods in the treatment of these patients was overcome. Algorithms for the use of fibrobronchoscopy in the diagnosis and treatment of complicated pulmonary echinococcosis have been developed, and thoracoscopic pulmonary echinococcectomy has been successfully introduced as one of the first among the countries of the former USSR.
A large number of surgical interventions were performed for tumors and cysts of the mediastinum of various origins. The huge experience of the department in the surgery of myasthenia is considered remarkable. Complex reconstructive interventions for scarring stenosis of the trachea, such as circular resection of the trachea, tracheoplasty using a T-shaped tube and elimination of a defect in the anterior wall of the trachea with microsurgical flaps, are also currently underway.
Introduced in the 70s, adrenal surgery in recent decades has acquired new modern capabilities with almost complete prevention of fatal cases after removal of the most complex hormone-containing adrenal tumors.
The department is a pioneer in conducting choledochoscopy for pathologies of the biliary tract, reconstructive surgery for iatrogenic injuries of the common bile duct.
For the first time in the republic, at the department carried out portocaval and organ anastomoses in case of liver cirrhosis, performed endoscopic sclerotherapy for bleeding from varicose veins of the esophagus.
Since 1975, the devision of vascular surgery has been operating on the basis of the department. Employees of the department are leading specialists of this unit. Currently, almost all types of non-invasive and invasive diagnostic methods, surgical interventions for various arterial and venous pathology have been introduced into the practice of this service. Diagnostic and treatment methods for chronic venous insufficiency, post-thrombotic disease and venous trophic ulcer, where along with traditional interventions, X-ray endovascular, laser, endoscopic technologies are considered as priority ones.
The range of scientific and practical implementations in the pathology of the vascular system is wide. Diagnostic methods have been successfully implemented in the practice of the clinic and quite complicated surgical interventions are performed for severe occlusive lesions of the vessels that feed the brain, upper thoracic aperture syndrome and chronic brachial ischemia, chronic abdominal ischemia, vasorenal hypertension, aortic aneurysms and major arteries, whichonly large specialized agencies can do it. A number of original operations have been developed, such as transaxillary resection of the first rib, selective cervicothoracicsympathectomy, including thoracoscopic, in case of upper aperture syndrome and Raynaud's disease. Indications for various methods of revascularization of the upper extremities are systematized and developed, depending on the level of localization of the lesion. With multistory occlusions of vessels of the upper and lower extremities, the limb was revascularized for the first time by free microsurgical transplantation of a large omentum, which in the world had no analogue.
During the period of local military conflicts in the republic, the department’s staff studied the surgical treatment of gunshot wounds of blood vessels in a civil war. The causes of late diagnosis and tactical errors in the provision of medical care in hospitals of the district level were studied, the volume of surgical interventions and the sequence of their implementation in case of combined and multiple vascular-organ injuries were determined. A system of adequate hemostasis for wounds of vessels of "complex" localization (gluteal and intracanal arteries) by means of a two-system ligation has been developed. In critical limb ischemia due to gunshot wounds of blood vessels, criteria for assessing tissue viability, indications and techniques for performing primary amputation of limbs, etc. are determined, due to which the rates of complications and deaths are reliably reduced, the frequency of limb amputations is reduced. Implementation data has also gained recognition outside the republic. To date, more than 200 types of various surgical interventions have been introduced into practice.
In recent decades, neweendo-vascular methods for the diagnosis and treatment of vascular pathologies have been introduced into practice. The first implants of this kind were vibromechanical recanalization with segmental occlusive arterial lesions. As an alternative to the method, dilatation angioplasty of arteries with stenting, which is also introduced into the practice of the clinic and carried out with lesions of the brachiocephalic vessels, renal arteries, and also major arteries of the extremities, is considered today.
It should be noted that at the 80s of the last century, department staff actively carried out extensive experimental work to study the influence of extreme high-mountain factors on wound healing processes of various origins. Scientific developments in the experiment were also carried out in parallel with respect to the effect of a low-intensity helium-neon laser on the regeneration of gunshot and thermal wounds, and on the body as a whole, with its general and local application in extreme conditions of high mountains.
The most important and complex problem, which for many years has been within the scope of the department, has been and remains cardiac surgery. Initially, in the 60s, closed mitral commissurotomy, ligation of the open ductusarteriosus, pericardectomyin adhesive pericarditis were introduced into practice. Since 1988 open heart operations were performed using an artificial blood circulation apparatus (ABCA), which expanded the possibilities for complex operations with congenital and acquired heart defects.
The development of cardiac surgery is primarily associated with the use of high-tech equipment. Events of the 90s in republic, the collapse of the Soviet Union had a sharp impact on the performance of complex, costly surgical interventions, especially on the heart and large vessels. It should be emphasized that despite the difficult economic situation of the republic and the consequences of the civil conflict in the first years of independence of the republic, in 1998, on the personal initiative and support of the Leader of the Nation, President of the Republic, EmomaliRahmon, the base of the department was enriched with X-ray surgical complex, video endoscopic equipment, and an advanced laboratory complex. This gave a tangible impetus to the development of advanced surgical techniques in Tajikistan. Complex diagnostic tests have been carried out, in particular coronary angiography, selective angiography of the vessels of the brain, kidneys, abdominal organs and limbs. Coronary artery stenting for coronary heart disease and various variants of angioplasty for stenotic lesions of arteries, plastic surgery of atrial and interventricularseptal defects of the heart by an angiographic method have been introduced into practice.
Large researches have been conducted to study and treat patients with chronic pericarditis, which made it possible to reduce the frequency of subtotal pericardectomy due to the development of adhesive pericarditis. In particular, open methods of pericardial drainage and thoracoscopic fenestration of the pericardium with intense exudative pericarditis proved to be effective.
In 1985, for the first time in the republic, a new surgical service was created with the introduction of microsurgical technology. Professor ArtykovKarimdzhonPulatovich, Honorary Medical Officer of the Republic of Tajikistan, Laureate of the Lenin Komsomol Prize in Tajikistan, Laureate of the State Prize named after AbualiIbni Sino, plays a great role in the creation and establishment of microsurgery, reconstructive plastic surgery in the republic. He headed the department in 2010-2018. The introduction of this area of surgery has expanded the possibilities of rehabilitation of patients with traumatic amputations of segments and fingers of the upper extremities, severe injuries of the hand, limbs, injuries of the neurovascular bundles, and the consequences of post-burn contractures of the limbs, face and trunk. Such surgical interventions as implantation of fingers and segments of limbs, autotransplantation of complex revascularized tissue complexes, various options for reconstructive interventions on the nerve trunks of the extremities, reconstructive surgery for congenital anomalies and post-traumatic contractures of the hand, limbs, face and body have been successfully introduced into practice.
In severe and combined injuries of limb structures, an algorithm has been developed for the treatment of victims, which prefers simultaneous restoration of blood circulation in the damaged limb with primary covering of defects in integumentary tissues with flaps with axial blood supply. This tactic allowed reducing amputation rates, completing the main stages of reconstruction in one stage, shortening the duration of rehabilitation and decreasing the indicators of disability in victims.
Initially, a new approach to the surgical treatment of large and giant primary and postoperative ventral hernias was introduced into the practice of the clinic, and later in many departments of the republic, which, taking into account the anatomical and functional features of the anterior abdominal wall, offers the use of abdominoplasty technology to eliminate hernia gates. Further development of this service contributed to the introduction of complex types of local plastic surgeries, expander dermatotension in the correction of extensive scars of integumentary tissues. A new stage is the widespread aesthetic surgery on the face, neck, mammary gland and other parts of the body.
Employees of the department are active adherents of the principle of minimally invasive surgery and thanks to the development of endovideoscopictechnology, this principle has been successfully implemented in operations on the organs of the chest and abdominal cavities, retroperitoneal space and pelvic organs since 1999. Along with general surgical interventions on the organs of the abdominal cavity, this technology has been actively introduced in surgical pathologies of the cardiovascular system. In particular, thoracoscopic pericardial fenestration, excision of pericardial and mediastinal cysts, thoracic and lumbar sympathectomy, endoscopic dissection of perforating veins of the lower extremities in chronic venous insufficiency are performed.
From 2018 to this day, the department is headed by the Doctor of medical sciences, associate professor MalikovM.Kh., who is the person trainee of this department.
Throughout the entire period of its activity, the department is engaged in teaching activities with 5th and 6th year students; annually from 5 to 10 clinical residents in surgery complete their studies at the department, 4-6 graduates of the medical university undergo internships. Along with pedagogical and medical activities, the department is engaged in scientific work and the preparation of scientific and pedagogical personnel. The contribution of the department to train highly specialized staffs is huge and a whole doctors, trained on the walls of the department works as teachers and practitioners in all regions of the republic and beyond. Research work on 27 major problems has been completed. Defended 14 doctoral and 72 master's theses. The results of the research department are reflected in more than 2500 articles in leading specialized journals, published in 15 monographs. Obtained 32 patents for inventions, more than 200 innovation proposals. For educational purposes, 35 methodological developments, 4 study guides were published. On the basis of the department, courses of primary specialization in plastic and reconstructive surgery, vascular and endolaparoscopic surgery are conducted.
The works of the department staff are highly appreciated by the Government of the Republic of Tajikistan, the Ministry of Health and Social Development and the leadership of Avicenna TSMU. In particular, the title of academician of the Academy of Sciences of the Republic of Tajikistan was awarded to one, corresponding member of AMS RT to three employees of the department. For the enormous contribution to the development of medical science, the title of Honored Scientist of Science was also awarded to three members of the department. Numerous employees have become excellent students of healthcare and higher education of the republic. For the development of vascular surgery in the republic, the training of medical personnel to four employees of the department in 2003, the Abuali Ibni Sino State Prize was awarded, for the development and implementation of microsurgical technology in clinical practice, 5 employees of the department were awarded the Lenin Komsomol Prize of Tajikistan.