Introduction. The choice of antireflux intervention directly affects quality of life and the risk of disease recurrence. “Gold standard” to date is laparoscopic fundoplication according to Nissen. Laparoscopic gastroplication of A.F. Chernousov’s is popular in our country, the results of which are effective and safe.
Aim: comparison of the results of surgical treatment of two techniques: laparoscopic Nissen fundoplication and gastroplication in A.F. Chernousov's.
Materials and methods. The group of authors carried out a retrospective evaluation of the results of immediate clinical observations, as well as archival data of the patients operated from December 2023 to September 2024 at the bases of the City Clinical Hospital “M.E. Zhadkevich” and City Clinical Hospital «I.V. Davydovsky». The study included 109 patients who underwent laparoscopic Nissen fundoplication with the formation of a free short cuff (main group n=57) and laparoscopic gastroplication in the modification of A.F. Chernousov’s (control group n=52).
Results. The median blood loss in the main group was 50 ml versus 120 ml in the control group. The average duration of surgery in the main group was 79 min, in the control group – 92 min. There were no intraoperative complications in both groups. There were no postoperative complications according to the Clavien-Dindo 3 in both groups. The average duration of hospital treatment was 3,9 days and 4,2 days, respectively.
Conclusion. The results obtained did’t show a statistically significant difference when comparing the two techniques.

Introduction. Splenic cysts often require surgical intervention to prevent complications such as rupture or infection of the cyst. The traditional method of treating patients is splenectomy, but given the associated risks, such as overwhelming postsplenectomy sepsis, infectious and thrombotic complications, partial spleen resection has been introduced into clinical practice. Given the rapid development of minimally invasive surgery, it has become possible to perform this intervention using laparoscopic and robot-assisted technologies. However, the experience of performing robot-assisted partial spleen resection (RPSR) in world practice is extremely limited, therefore, it is impossible to conduct evidence-based comparative studies of this surgical technique.
Materials and methods of research. From 2023 to 2025, seven patients (4 men, 3 women; average age 43,1 years) in the surgical clinic of the S.P. Botkina underwent RPSR for benign cystic lesions of the spleen. Preoperative vaccination (pneumococcal, meningococcal and hemophilic type B) was performed one month before the surgery. Based on the anamnesis, clinical picture and data obtained during imaging, hydatid cysts were diagnosed in 3 patients, in 4 cases the neoplasms were assessed as epithelial simple cysts of the spleen. All patients were indicated for surgical intervention, taking into account the etiology of the neoplasm, size or rapid growth. Surgery time, blood loss, postoperative complications and length of hospital stay were recorded for statistical analysis.
Treatment results. All seven robotic-assisted partial spleen resections were successfully performed without cases of conversion to open surgery. The mean procedure time was 136 minutes (range 78–210 min) excluding robotic docking, mean blood loss was 78,6 ml (range 20–150 ml). No serious complications (Clavien-Dindo II–V) were observed in any case. One patient with a cyst 8,6 cm in diameter developed a postoperative wound seroma. The mean hospital stay was 3,6 days (range 3–5 days). During the follow-up, no postoperative infectious and thrombotic complications, splenic infarctions and pancreatic fistulas were observed.
Conclusion. Robot-assisted partial spleen resection is a safe and effective alternative to laparoscopic surgery. The advantages of the robotic system minimize the risk of intra- and postoperative complications, as well as rapid patient recovery after the procedure. Further studies are needed to compare resection methods and optimize surgical approaches.

Introduction. Despite the lack of studies with a high level of evidence regarding the effectiveness of VAC-laparostomy in severe forms of secondary peritonitis, significant experience in the application of this surgical strategy has been accumulated in practical surgery, and the accumulated results make it possible to analyze possible contraindications and risk factors for the use of this technique.
The purpose of the study. To detail contraindications to vacuum-assisted laparotomy in the surgical treatment of secondary peritonitis complicated by abdominal sepsis.
Materials and methods of research. The results of treatment of 84 patients with abdominal sepsis treated with vacuum-assisted laparostomy (VALS) were analyzed. In all patients, abdominal sepsis was the result of secondary peritonitis, the source of which was defects in various parts of the gastrointestinal tract (GIT). Most patients (85,7 %) were diagnosed with septic shock at the time of initial surgery, and many patients (81 %) underwent surgery later than 24 hours after the onset of the disease. The correlation of treatment results what depending on the initial localization of the source of peritonitis.
Treatment results. The overall mortality rate in the study was 38 %. In the group of patients with localization of the source of peritonitis in the small intestine, mortality was 52,8 %. In the group of patients with the source of peritonitis in other parts of the gastrointestinal tract, mortality was 27 %. The difference in mortality in the groups was significant (p<0,05). The success rate of primary fascial closure (PFC) was also significantly different in the groups (31,3 % vs. 82,5 %, p<0,05).
Conclusion. There is reason to believe that in the presence of sutured areas or areas of damage to the serous membrane of the small intestine in secondary peritonitis, it is necessary either to completely abandon the use of VALS, or to use reduced versions of vacuum dressings, which provide for the effect of negative pressure only within the laparotomy wound with isolation of the negative pressure zone from the free abdominal cavity with synthetic prostheses fixed to the fascial edges of the wound.

The aim of the study. To analyze the results of endoscopic retrograde stenting of bile ducts in patients with mechanical jaundice of tumor genesis.
Materials and Methods. The results of endoscopic biliary stenting in 64 patients with mechanical jaundice of tumor genesis as palliative care in the period from 2016 to 2022 were analyzed.
Results. In 17 patients (26,6 %) there were moderate intensity pain syndrome. Postmanipulation acute pancreatitis developed in 2 patients (3,1 %). Technical success was achieved in 58 patients (90,6 %). Clinical success was achieved in 89,1 % of cases. 6 patients (9,3 %) underwent antegrade percutaneous transhepatic bile duct drainage. The migration rate was 1.6 % of cases (1 patient). In 3 months after the operation the repeated endoscopic stenting of bile ducts was performed in 14 patients (21,9 %). Plastic stent encrustation was detected in 8 patients (12,5 %). 4 patients (6,2 %) undergoing endoscopic restenting of bile ducts with a metal stent of “stent-on-stent” type against the background of repeated tumor obstruction of the metal stent were performed. The three-month mortality rate in the studied group of patients amounted to 20,3 %.
Conclusion. Application of metal self-expanding stents allows to perform better and longer decompression of bile ducts. Endoscopic retrograde stenting of bile ducts is reasonable in the presence of distal tumor block of bile ducts, and in the presence of proximal tumor block it is more preferable to use the technique of antegrade percutaneous transhepatic drainage of bile ducts.

Introduction. According to Russian and European surgeons, the data of long-term results of surgical treatment of inguinal hernias have conflicting opinions about the use of polypropylene nets (Lichtenstein, TEP, TAPP), indicating a deterioration in fertility in men. Without detracting from the advantages of these techniques, we propose plastic surgery of the inguinal canal with a parietex anti-adhesive mesh.
The aim of our work is to improve the results of surgical treatment of inguinal hernias and preserve male fertility in the reproductive age.
Materials and methods. To substantiate the proposed operation for inguinal hernias, we conducted experimental work on 12 animals. During the period 2019–2024, we operated on 166 patients, including 79 patients using our own technique, including recurrent inguinal hernias.
Results. Examination of patients of childbearing age with inguinal canal plastic surgery with anti-adhesive mesh paritex, before and after surgery, revealed no change in fertility indicators. In addition, no cases of recurrence have been identified. Conclusion. This technique can be recommended as an alternative for the treatment of the most common forms (small, medium, recurrent, non-reversible) inguinal hernias.

Introduction. A comparative analysis of the immediate and long-term results of various reconstruction options for gastrectomy according to Ru allowed us to present the intestinal reservoir as a functional element of the digestive tube with a pronounced protective function, contributing to a more effective adaptation of digestive processes after surgical removal of the stomach.
Research materials and methods. To determine the characteristic features of the postoperative course, the immediate and functional results of gastrectomy with the formation of a proximal intestinal reservoir on the Ru loop, a retro- and prospective comparative multiparametric cohort analysis of the course of the immediate and long-term postoperative period was performed in 133 patients (average age 63.3±6.1 years) who underwent gastrectomy with a general scheme of reconstruction according to Ru and various variants esophago-enterostomy, for the period from 2019 to 2024.
Results. The formation of a proximal intestinal reservoir on the loop with invagination transverse esophago-enteroanastomosis was accompanied by a minimal number of intra- and extra-abdominal complications, no deaths, early recovery of the motor evacuation function of the digestive tube, a minimal number of patients with postoperative reflux esophagitis and a significantly higher quality of life.
Conclusion. The presented functional results of using the technique of forming a proximal intestinal reservoir on a loop with invagination transverse esophago-enteroanastomosis make it possible to consider the use of this surgical technique in a modern surgical clinic as legitimate and appropriate.

Introduction. Medicine is developing rapidly, and surgery is one of its most important areas. A new achievement has been the practice of simultaneous operations – multiple interventions simultaneously or in a short period of time. This opens up new opportunities for patients and doctors. However, the introduction of simultaneous treatment is hampered by economic factors, as insurance companies pay for only one intervention. The decision is made in favor of modern technologies that benefit patients and the state.
Materials and methods. The results of surgical treatment of 224 patients with vascular pathology and other surgical diseases were analyzed. The operations were performed from 2020 to 2024 in the departments of surgery of the State Medical Institution "Surgical Center" and cardiovascular surgery of the Republican Clinical Hospital on the basis of the Department of Hospital Surgery of the Kabardino-Balkarian State University named after H.M. Berbekov. In the comparison group (110 patients), staged operations were performed.
Results. The analysis of the perioperative period revealed no significant difference in the parameters of simultaneous operations: duration, blood loss, increased dose of catecholamines, rhythm disturbances, duration of artificial ventilation and hospital stay. Conclusion. Simultaneous operations do not lead to an increase in the number of complications and mortality, even in complex pathologies. The use of simultaneous operations makes it possible to provide highly qualified surgical care, reduce the number of complications and shorten the hospital stay.

Introduction. This article presents a five-year clinical observation of 100 patients with concomitant bone pathology, as well as diabetes mellitus and reduced left ventricular ejection fraction. All patients underwent surgical treatment of cardiac pathology using various approaches.
The purpose of the study. To determine the influence of modifiable risk factors on the development of complications of postoperative chest wounds.
Materials and methods of research. Of 4,000 patients, 100 were selected. 47 patients were male and 53 were female. The average age was 60 years. The patients were divided into two groups. The first group of patients had a standard sternotomy approach. The second group of patients underwent mini-J sternotomy and minithoracotomy.
Treatment results. In patients who underwent surgery through a mini-access, the number of cases of respiratory and cardiac failure, septic conditions decreased. Also, in these patients, the number of cases of sternomediastinitis and soft tissue diastasis in the early postoperative period statistically significantly decreased. At the same time, no fatal outcomes were recorded in either group.
Conclusion. After evaluating the postoperative results, conclusions were made about the advantage of minimally invasive access over full longitudinal sternotomy. A positive effect was also established from the use of mini-J sternotomy and mini thoracotomy as a faster recovery of the patient in the early postoperative period.

Introduction. The problem of recurrence of varicose veins of the lower extremities remains relevant.
The purpose of the study. The aim of our study was to optimize the results of varicose veins recurrence treatment by introducing the total endovasal laser ablalation (total-EVLA) technique.
Material and methods. The work analyzes the results of diagnostics and treatment of 17 patients with true recurrences of varicose veins. All individuals were re-operated at the Clinical Hospital № 4 of Sechenov University at 2021–2024 period using the "total-EVLA" technique.
Results. Technical and clinical success of repeated surgical correction of varicose veins recurrence was achieved in all cases.
Conclusion. Use of EVLA among patients with recurrent varicose veins avoids traumatic manipulations in the area of cicatrical-changed tissues in order to significantly reduce the risk of damage to important anatomical structures, reduce the duration of the surgery, improve patients’ quality of life of, while increasing the final aesthetic result of the treatment. The "total-EVLA" technology can be recommended for radical correction of recurrent varicose veins – regardless of the localization and volume of the subcutaneous venous system damage.

Introduction. To identify prognostic indicators associated with the development of surgical site infections (SSIs) following elective thoracotomy.
Materials and methods. The study was conducted at the Thoracic Oncology Surgery Department of the State Healthcare Institution of Ulyanovsk Regional Cancer Center. The analysis included patients who underwent lobectomy or atypical resection between January 1, 2021, and December 31, 2023 (Database RU 2024622259 dated May 24, 2024). A total of 468 patients were included, of whom 32 (6,8 %) developed SSIs.
Results. The incidence of SSIs was 32/468 (6,8 %). Univariate analysis revealed statistically significant predictors of SSI development: age (p = 0,022), presence of diabetes mellitus (p < 0,001) and obesity (p = 0,043), the extent of surgical intervention (p = 0.003) and its duration (p < 0.001), the stage of COPD (p = 0,043), intraoperative blood loss (p < 0.001), and postoperative air leakage (p < 0,001). Multivariate analysis identified statistically significant indicators: the presence of diabetes mellitus (OR 7,286; 95 % CI 3,083–17,219; p < 0,001), surgery duration (OR 1.013; 95 % CI 1.004–1.023; p = 0.007), volume of blood loss (OR 1,004; 95 % CI 1,001–1,007; p = 0,007), and prolonged air leakage (OR 4,444; 95 % CI 1,677–11,775; p = 0,003).
Conclusion. The incidence of SSIs following surgical treatment for lung diseases was 32 cases (6,8 %), of which 59,4 % corresponded to grade 2 on the Southampton scale.

Introduction. To evaluate and compare the quality of life and psychological status of patients after laparoscopic surgery for rectal cancer with Natural Orifice Specimen Extraction Surgery (NOSES) and with the conventional laparoscopic.
Materials and methods of research. This prospective study included patients at Sechenov University and Harbin medical university. Patients were segregated into NOSES group and CL group based on case-match method. QoL was assessed using the short-form 36 health survey (SF-36), Beck anxiety inventory (BAI), and Spielberger state-trait anxiety inventory (STAI) pre-operation, pre-discharge, postoperative 3 months, and postoperative 6 months.
Treatment results. A total of 30 patients (15 in NOSES group and 15 in CL group) were included. At three months postoperatively, role function, physical pain, and emotional state were better in the NOSES group than in the CL group (all p<0.05). At six months postoperatively, NOSES group patients with better than CL group patients in role function, physical function, vitality, social function, emotional state, and mental health (p<0.05). As for postoperative depression, patients in the NOSES group were significantly better than patients in the CL group before discharge (p=0.037) and three months after surgery (p=0.003). In terms of anxiety, patients’ state anxiety in the NOSES group were lower than CL group before discharge (p=0.016), and trait anxiety were better than CL group (p=0.015).
Conclusion. This research provides compelling evidence that NOSES offers significant advantages in postoperative QoL, psychological well-being, with comparable surgical outcomes of the CL approach.

Introduction. Malnutrition is a major problem in patients with colorectal cancer, affecting the incidence of postoperative complications, length of hospital stay, and overall survival. The present study aims to evaluate the effect of postoperative nutritional support on clinical outcomes in patients with colorectal cancer and malnutrition.
Materials and methods. A prospective, randomised, controlled trial was conducted in 170 patients with colorectal cancer and identified malnutrition undergoing elective surgery. Patients were randomly divided into two groups: a specialised therapeutic nutrition group and a control group. The incidence of postoperative complications, albumin levels, inflammatory markers (crp, nlr, plr, apri) and length of hospital stay were evaluated.
Results. The use of specialised therapeutic nutrition in the postoperative period helped to reduce the incidence of all postoperative complications (21 % vs. 41 %, p<0,006), including infectious complications (8 % vs. 22 %, p=0,018). Patients on total parenteral nutrition had a faster recovery of albumin levels and a significant decrease in inflammatory markers (crp, nlr, plr, apri). The mean length of hospital stay was significantly shorter in the therapeutic nutrition group (14 [12; 17] days vs. 17 [14; 22] days, p<0,0001).
Discussion. According to the results of the study, malnutrition is a significant risk factor for postoperative complications. The use of specialised therapeutic nutrition improves the nutritional status of patients and has a pronounced anti-inflammatory effect, reducing the risk of complications and accelerating recovery. This study demonstrates for the first time the effectiveness of postoperative specialised therapeutic nutrition in patients with colorectal cancer and malnutrition.
Conclusion. This study is the first of its kind, not only in Russia, confirming the clinical benefits of specialised therapeutic nutrition in colorectal cancer patients with malnutrition in the postoperative period, which emphasises the need to implement standardised protocols of nutritional support to reduce the incidence of complications and improve postoperative recovery

Introduction. The issues of postoperative rehabilitation of patients with intermuscular phlegmon of the thigh are of particular interest due to the prevalence of pathology, a high percentage of unsatisfactory treatment results.
Purpose of the study. To develop a set of measures aimed at the correction and rehabilitation of patients who have undergone surgical treatment for intermuscular phlegmon of the thigh and acute tissue hypotensive syndrome (compartment syndrome).
Materials and methods. The clinical section of the work was performed on 65 patients with intermuscular phlegmon of the thigh (IFT), purulent form. The set of diagnostic and treatment methods included, in addition to traditional methods, monitoring of tissue pressure (Stryker monitor). Quality of life was assessed using the SF-36 scale.
The severity of myofascial pain syndrome (MFPS) was studied using the method of A.F. Khabirov. The condition of the thigh muscles before and after surgery was determined by studying the muscle strength test (TMS) and electromyographic activity (EMG) on the Neuro-MEP-4 device.
Results and discussion. Based on the results of remote monitoring (6 months), the number of good results in patients of the main group was 1,7 times higher than in the control group, which used traditional methods (p < 0,05). The rate of satisfactory treatment results decreased by 3,5 times, unsatisfactory results were not recorded, while in group II their number was 16,2 %. At the same time, the overall quality of life in group I was higher by 33,9 %.
Conclusions. The developed complex of therapeutic and diagnostic measures made it possible to achieve high rates of rehabilitation effectiveness and quality of life.

Introduction. Lipoabdominoplasty is a combination of liposuction and abdominoplasty aimed at improving the aesthetic and functional characteristics of the anterior abdominal wall. One of the key aspects of successful surgery is the choice of the electrodissection method. This study is devoted to a comparative analysis of the efficacy and safety of various electrodissection modes in lipoabdominoplasty.
Materials and methods. The study involved 90 patients who underwent lipoabdominoplasty using various electrodissection modes: monopolar coagulation, monopolar cutting and Valleylab mode. Patients were equally distributed between the groups, and the effectiveness was assessed by the duration of surgery, blood loss, hospital stay, and the incidence of postoperative complications.
Treatment results. Data analysis showed that the group using the Valleylab mode tended to have fewer complications, less blood loss, and shorter hospital stays. These patients recovered faster, which may be due to the more gentle and precise effect of this mode on tissues.
Conclusion. The choice of the electrodissection method plays an important role in reducing the incidence of complications and improving the results of lipoabdominoplasty. Although the differences in the incidence of seromas and hematomas between the studied groups did not reach statistical significance, the trend towards better results in the Valleylab group indicates that its use is promising. Further studies will help to clarify the advantages of this method and optimize surgical technique.

Introduction. Esophageal cancer and benign stricture in a number of cases lead to the development of progressive dysphagia and marked disturbances in the nutritional status of the patient. In older patients with a long list of concomitant diseases, stenting allows to adequately solve the nutritional problem and avoid radical traumatic surgery with unpredictable outcome. However, stent dislocation or its failure in case of lumen closure by tumor or excessive granulation leads to recurrence of progressive dysphagia. An individualized approach to the assessment of functional parameters of the patient's condition allows planning radical surgical treatment.
Clinical case. The patient is 82 years old, who underwent esophageal endoprosthesis at the hospital of his place of residence. In August 2023, he came to a medical institution with complaints of difficulty in passing solid food and discomfort in the chest. A complex examination revealed a grade III stenosis of the distal esophagus. A decision was made to endoprosthetize the esophagus. On the background of the treatment the patency of the esophagus was restored. However, a month later difficulties in passing solid food, regurgitation with blood streaks, weakness, he lost 10 kilograms of weight during the last month appeared again. He was hospitalized to clarify the diagnosis and decide on the treatment tactics.
Purpose of the study. Demonstration of successful performance of radical surgical treatment of progressive dysphagia in esophageal tumor stricture after ineffective stenting.
Conclusion. Esophageal extirpation with its one-stage gastric stalk plasty is the operation of choice in the surgical treatment of malignant stenosing esophageal diseases when endoscopic methods cannot be applied or become ineffective. Naturally, it is performed taking into account the individuality of each clinical case and requires a multidisciplinary approach.

Introduction. Primary multiple breast malignancies are of great importance both in oncology and in reconstructive surgery. The choice of breast reconstruction method often determines not only the objective parameters and skills of the surgeon, but also the tasks that the patient himself sets for him, taking into account the fact that reconstruction primarily solves issues of psycho-emotional health.
Materials and methods of research. Currently, the thoracodorsal flap is the gold standard and is actively used both after mastectomy and during organ-preserving surgical treatment in order to replenish the removed breast area. It is versatile in its application and has a reliable vascular stem.
The results of the treatment. The thoracodorsal flap can be successfully used in bilateral breast reconstruction. Achieving symmetry not only in the donor area, but also in the recipient area, combined with the relatively simple technique of performing surgery and the high reliability of these flaps, indisputably determines the importance of this method of autologous reconstruction.
Conclusion. The key to the success of breast reconstruction is considered to be carefully thought-out tactics at the planning stage. The advantages of using a thoracodorsal flap determine a high assessment of the importance of this technique in bilateral reconstructive breast surgery.

The rapid development, constant development and implementation of new methods and technologies in plastic surgery invariably cause a lot of discussion in the literature.
The social and medical importance of plastic surgery is the treatment and prevention of the development of severe somatic conditions.
The paid basis of plastic surgery. The services of a plastic surgeon are not covered by either compulsory medical insurance or VMI, and the industry is not funded or subsidized by the state. Based on this, the only way to survive and develop is to provide paid services.
Plastic is developing rapidly and dynamically, including conducting scientific research using a variety of new technologies.
Recently, there has been fierce debate among plastic surgeons about the expediency of a five-year clinical residency for plastic surgeons.
All the issues raised in the article currently have no clear solution and require further discussion.

Introduction. An increasing number of people, including the older generation, are choosing an active lifestyle. However, in this regard, the number of diseases associated with degeneration of skeletal tissues is rapidly increasing. The relevance of the work is due to the fact that coxarthrosis is a socially significant disease, due to the frequent temporary or complete disability of the population, as well as due to the significant economic costs of treatment.
Purpose: the main purpose of this work is to summarize current knowledge about the pathophysiological features of coxarthrosis, methods of its diagnosis and treatment.
The main part. A review of the literature on modern aspects of etiology, classification, pathogenesis, and clinical presentation has been conducted. The main modern diagnostic methods are identified, their disadvantages and advantages are evaluated. The clinical efficacy of both drug therapy and non-drug treatment methods has been evaluated. The aspects of surgical treatment of coxarthrosis are considered. Special attention is paid to the issues of choosing the optimal surgical access when performing hip arthroplasty.
Conclusion. A significant increase in the number of patients suffering from coxarthrosis, a dramatic rejuvenation of the disease requires a detailed assessment of modern treatment methods and the development of new approaches to surgical treatment in order to reduce complications and accelerate the rehabilitation of patients.

The long-term prospects of allohernioplasty are determined by the inclusion of tissue in the frame of the mesh implant, the degree of tissue ingrowth affects the formation of relapse, and resistance to chronic infection and the return of tissue to the original structure determine the functional result.
Meshes cause an acute inflammatory reaction; if it is intense – a granuloma is formed. An increase in the amount of connective tissue does not always lead to the strength of hernioplasty. The formation of coarse scar tissue is accompanied by a change in tissue elasticity, leading to wrinkling, thickening, mobility of the implant and recurrence of the hernia.
Chronic pain after allohernioplasty (1–18% of patients) associated both with the surgical technique and with the presence of postoperative inflammatory complications leading to tissue fibrosis, mesh shrinkage and involvement of nerve trunks.
Regulation of inflammatory cell migration into the hernia repair area defines a strategy for modulating the inflammatory response. The use of biological adhesives is accessible and effective. Fibrin glue is an expensive drug that is not reliable from the point of view of quarantine safety. Autologous platelet-rich plasma (PRP) is easier to obtain, rich in growth factors that influence cellular mechanisms, and may be a tool for improving mesh implant integration. A review of the world literature shows isolated observations on the use of PRP in experiments, so studying the mechanisms of the influence of PRP on the integration of a mesh implant into the patient’s tissue is relevant.

Introduction. One of the reasons for unsatisfactory local control of rectal cancer may be metastatic lesions of the lateral pelvic lymph nodes. Eastern and Western strategies for preventing local recurrence of this disease have developed in different directions. If in Japan lateral lymph node dissection has become a mandatory addition to total mesorectumectomy, the Western concept relies on the sanitizing effect of preoperative irradiation of possible regional metastases.
Results. The article is a review of publications demonstrating the results of radiation exposure to the lymphatic collector of the lateral compartment of the pelvis in rectal cancer. The search for articles on the topic of the review was carried out using the Web of Science and PubMed databases. In the course of the literature analysis, 94 sources were studied, of which 30 were selected to form the review. Most of the presented publications indicate the need for surgical removal of enlarged lateral lymph nodes due to the inability of radiation therapy to reliably ensure complete regression of lymphogenous metastases.
Conclusions. The currently available data do not allow us to consider radiotherapy as a radical method of treating lateral pelvic metastases. However, further study of options for increasing the radiation load on this area may, to some extent, limit surgical aggression towards this lymph collector.

Today, the world literature notes the actualization of the problem of diastasis recti abdominis (DRA). If earlier it was believed that diastasis is just an aesthetic problem, today many works have been published indicating that DRA significantly reduces the quality of life of patients and is a risk factor for the occurrence of hernias of the anterior abdominal wall, which makes the topic a relevant subject for study. A search and analysis of literary sources in the abstract databases PubMed, eLibrary, etс. for the past 10 years was conducted, more than 40 scientific publications were studied. Based on the analysis, the results and technical features of various minimally invasive methods for correcting DRA, as well as hernias of the linea alba, were studied, statistical data were assessed, and advantages over open treatment techniques were identified and described. Based on the conducted scientific research, it can be concluded that the combination of DPM with hernias of the white line of the abdomen is a fairly common problem, while the fact of the presence of a hernia should mainly determine the tactics of surgical treatment, namely the choice of surgical technique aimed at one-stage elimination of the hernia and correction of diastasis. Among the considered surgical techniques, surgical interventions from a mini-access with endoscopic assistance are the safest and most effective in comparison with open techniques due to a more pronounced cosmetic effect, a decrease in postoperative pain syndrome, as well as an acceleration of the rehabilitation period for patients.

Introduction. Extensive purulent-necrotic wounds remain an urgent problem of modern medicine, despite advances in surgery and therapy. They can occur due to complications of diabetes mellitus, surgical interventions, limb ischemia or infectious processes such as necrotizing fasciitis. The main difficulties in the treatment of these wounds are abundant plasma loss, slow growth of granulation, lack of plastic material for closing defects and a high risk of secondary complications.
The purpose of the study. Analysis of the effectiveness of the local negative pressure (LNP) method at the reconstructive-plastic stage of treating extensive purulent-necrotic wounds in combination with other plastic methods.
Materials and methods of research. The article summarizes the data of clinical observations, meta-analyses and studies considering options for using local negative pressure in combination with different types of autodermoplasty.
Conclusion. The local negative pressure method has proven itself as an effective means of stimulating wound healing, improving conditions for plastic surgeries and reducing the risk of complications. LNP promotes the growth of granulation tissue, revascularization of grafts and a decrease in bacterial load. However, its use requires consideration of wound characteristics, possible limitations and complications, as well as further research to optimize therapy parameters.

Introduction. Intraoperative macroscopic assessment of thyroid diseases is difficult. Fibrosclerotic alterations in the thyroid gland may be found in its benign diseases as well as in malignant neoplasms. The non-specificity of these alterations creates difficulties for the final decision on the extent of surgery.
The purpose of the study. To evaluate the clinical significance of fibrosclerotic alterations in the thyroid gland based on literature data.
Materials and methods of research. Search for literature data in the E-library database using the keywords “fibrosis”, “sclerosis”, “calcification”, “hyalinosis”, “thyroid gland".
Treatment results. Increase of the thyroid stromal connective tissue is a frequent reason for macroscopically seen structural changes and hormonal shifts. The fibrosis and hyalinosis in benign thyroid diseases is a factor for hypothyroidism. The fibrosis, hyalinosis, sclerosis and calcification are the signs of an irreversible transformation with a high probability of tumor and probably is a risk factor of its aggressiveness. Nevertheless, fibrosclerotic alterations in the thyroid gland is not an obligatory sign of a malignant process. Moreover, on morphological examination the process often turns out to be benign. However, the presence of fibrosclerotic alterations is an additional factor for making a decision about the increase of the extent of surgery.
Conclusion. Modern diagnostic methods make it possible to diagnose thyroid disease morphologically with a high degree of accuracy before surgery. However, in the presence of local or widespread thyroid fibrosis, the surgeon must decide a question about the extent of surgery intraoperatively. The intraoperative ultrasound examination can facilitate this task.

Acute bleeding ulcer is still the main cause of hospitalization. This review presents a structured approach to the modern treatment of ulcerative bleeding and highlights the strategy in situations where there is a high risk. The initial methods of treatment – pharmacotherapy and endoscopy, as well as risk stratification, surgery and X-ray endovascular embolization are considered, and their role in the treatment of ulcerative bleeding with a high risk is critically discussed. The perspective regarding preventive X-ray endovascular embolization is highlighted. In addition to the achievements of pharmacotherapy and endoscopy, the treatment of bleeding with a high risk remains a difficult task. When endoscopy is ineffective and the bleeding does not stop or recurs, surgical and radiological methods are indicated for its relief. Surgical treatment is effective, but it is still associated with higher disability, prolonged hospital stays and mortality. Arterial embolization is recommended as an alternative to surgical intervention and more often replaces surgical in patients with severe comorbid background. Patients with this problem often belong to the elderly age group, which is associated with a severe comorbid background, and, therefore, a multidisciplinary approach to treatment is required. The treatment algorithm needs clear risk criteria and a structured treatment approach due to higher morbidity and mortality compared to conventional ulcerative bleeding. In addition, a promising approach of preventive embolization in peptic ulcer disease with a high risk requires further study.