Introduction. The heart is one of the main target organs in acute pancreatitis. Myocardial damage is associated with high mortality, but classical indicators (ejection fraction) often remain normal, which requires the search for more sensitive markers of dysfunction and understanding of the exact pathogenetic mechanisms.
The purpose of the study is to identify the specifics of myocardial damage in acute pancreatitis, which determines the pathogenesis of diastolic dysfunction, and to substantiate the prognostic significance of a new diagnostic indicator.
Material and methods. The work was completed in two stages. At the first stage, a comparative histological analysis of myocardial specimens from 104 deceased patients was carried out: 48 patients with acute pancreatitis, 36 with secondary peritonitis and 20 with purulent-necrotic lesions of the extremities. At the second stage, 136 patients with acute pancreatitis were examined. On the first day, all of them underwent echocardiography with the calculation of the author's diastolic coefficient (DC = EDV/IVS). The severity of pancreatitis was assessed based on the completed case (mild – 82, moderate – 43, severe – 11).
Research results and discussion. Histological examination revealed interstitial myocardial edema in 100 % of those who died from acute pancreatitis, which was significantly more common (p<0,05) than in the second group (77 %). Focal degeneration or absence of cardiomyocyte nuclei was found only in the pancreatitis group (12,5 %). At the same time, the left ventricular ejection fraction in patients with pancreatitis in 98,5 % of cases remained within the normal range and did not differ between severity groups. The values of the diastolic coefficient decreased significantly as pancreatitis became more severe: 9,72±0,41 in mild cases, 9,0±0,31 in moderate cases, and 7,23±0,49 in severe cases (p<0,05). The sensitivity of the proposed indicator was 83,9 %, specificity – 86 %.
Conclusions. The pathogenesis of myocardial damage in acute pancreatitis is determined by the direct toxic effect of pancreatic aggression factors, leading to interstitial edema, cardiomyocyte dystrophy and impaired myocardial elasticity, while classic systolic dysfunction (decreased ejection fraction) rarely develops. The developed diastolic coefficient objectively reflects the degree of these changes and is a highly sensitive prognostic marker of the severity of acute pancreatitis. Early use of this indicator is recommended for timely diagnosis of cardiac disorders and correction of therapy in patients with acute pancreatitis.

Introduction. Non-parasitic liver cysts are common benign hepatic lesions. Despite the widespread use of laparoscopic fenestration and percutaneous drainage with sclerotherapy, studies comparing the effectiveness of modern organ-preserving treatment modalities, including thermal ablation, remain limited.
The purpose of this study is to compare the efficacy and safety of organ-preserving treatment modalities for non-parasitic liver cysts, including laparoscopic fenestration, percutaneous drainage with sclerotherapy, and microwave ablation.
Materials and methods. The study included 153 patients with non-parasitic liver cysts. Group 1 consisted of 48 patients treated with laparoscopic fenestration, Group 2 included 54 patients who underwent percutaneous drainage with sclerotherapy, and Group 3 comprised 51 patients treated with microwave ablation. Clinical symptom regression, recurrence rates, postoperative complications, and perioperative outcomes were evaluated. Follow-up ranged from 1 to 5 years.
Research results and discussion. A significant reduction in clinical symptoms was observed in all groups during the first months after treatment. Recurrence rates were 16 %, 9 %, and 6 % in Groups 1, 2, and 3, respectively (p=0.182). No statistically significant differences were found in the incidence or structure of postoperative complications between the groups (p=0,260). Percutaneous procedures were associated with shorter intervention time, reduced length of hospital stay, and the absence of significant blood loss (p<0,001).
Conclusion. Laparoscopic fenestration, percutaneous drainage with sclerotherapy, and microwave ablation demonstrate comparable efficacy and safety in the treatment of non-parasitic liver cysts. Percutaneous interventions reduce surgical invasiveness and shorten hospitalization without compromising long-term outcomes.

Introduction. Nonparasitic liver cysts (NPCs) are a heterogeneous group of benign lesions united by a morphological feature – the presence of fluid – but differing significantly in etiology, pathogenesis, and morphogenesis. The prevalence of simple liver cysts in the general population reaches 15–18 %. The relevance of this pathology is associated with an increased detection rate due to the development of instrumental imaging techniques, as well as the presence of chronic abdominal syndrome and dyspeptic disorders in a certain group of patients. The aim of this study was to evaluate the efficacy and safety of a modern minimally invasive microwave ablation (MIMW) method in the treatment of symptomatic NPCs.
Materials and methods. From January 2022 to December 2024, a prospective, non-randomized study was conducted in the surgical department of the university clinic of the Russian University of Medicine of the Russian Ministry of Healthcare. The study included 18 patients with symptomatic NCPs who underwent percutaneous MVA. The inclusion criteria were: the presence of one or more (no more than 3) NCPs with a diameter of 4 to 12 cm; the presence of persistent abdominal pain syndrome and/or dyspepsia associated with the cyst; the absence of data on parasitic (negative serological tests for echinococcosis and alveococcosis) or tumor (absence of thickened septa, nodular component according to MRI with contrast) nature of the formation; informed consent of the patient. Exclusion criteria were: Gigot type III polycystic liver disease, signs of infection or hemorrhage in the cyst at the time of intervention, severe coagulopathy, general contraindications to interventional procedures. The study included 7 men (38,9 %) and 11 women (61,1 %). The mean age was 54,6 ± 12,3 years (range, 38 to 81 years). Fourteen patients (77,8 %) had a single cyst, and 4 patients (22,2 %) had two cysts. The mean maximum diameter of the dominant cyst, according to preoperative ultrasound, was 72,4 ± 15,8 mm (range, 42 to 110 mm). Cyst localization: 13 cases (72,2 %) in the right lobe and 5 cases (27,8 %) in the left lobe. All patients complained of dull pain or a feeling of heaviness in the right hypochondrium/epigastric region; 6 patients (33,3 %) experienced nausea after eating.
Treatment results. Technical success of the procedure (complete cyst drainage and ablation) was achieved in all 18 patients (100 %). The average procedure time was 35,4 ± 9,2 minutes. No intraoperative complications were recorded. The postoperative period was uneventful in 16 patients (88,9 %). Two patients (11,1 %) experienced low-grade fever (37,2–37,5°C) and moderate tenderness at the puncture site in the first 24 hours, which was assessed as post-ablation syndrome (grade 1 complication according to Clavien-Dindo) and was relieved with non-narcotic analgesics. The average inpatient follow-up was 1,8±0,7 days. Clinical symptoms (pain, discomfort) completely regressed in 15 patients (83,3 %) within the first week after the procedure. Long-term results. Follow-up data from 6 to 12 months (mean follow-up period 9,2 months) were available for all 18 patients. Ultrasound examination data at all follow-up periods showed a complete absence of fluid at the cyst site in 15 patients (83,3 %). In 3 patients (16,7 %) with initial cysts greater than 9 cm in diameter, a minimal residual serous cavity (mean size 8,5±3,2 mm) was detected after 1 month, which did not further enlarge.
Conclusion. Percutaneous microwave ablation of cyst walls after preliminary aspiration of its contents is a highly effective and safe minimally invasive treatment for symptomatic NCP. The method ensures a high percentage (83,3 %) of complete regression of cysts and persistent relief of clinical symptoms with a minimal risk of complications and short hospitalization periods.

Introduction. Changes in regional blood flow in the vessels of the abdominal cavity in acute pancreatitis are a complex and multifactorial process that is not only a consequence of the underlying disease, but also an active participant in its pathogenesis. Understanding these mechanisms is crucial for early diagnosis, predicting the course of the disease, and developing appropriate therapeutic strategies.
Aim. Analysis of hemodynamic disorders in the vessels of the abdominal cavity in acute pancreatitis.
Methods. The study involved 48 patients diagnosed with acute pancreatitis, 25 (55 %) men and 20 (45 %) women, with an average age of 44,3 ± 12,6 years). Patients with mild severity of OP – 37 (77,01 %) people, severe severity of OP – 11 (22,91 %) people. Ultrasound and CDK examination were performed on a Mindray DC-8 in PW-Doppler mode (Pulsed Wave Doppler).
Results. In most indicators of vascular hemodynamics, there is a statistically significant decrease in indicators from admission by day 5 in severe patients, while in lungs the dynamics is often insignificant or borderline. The differences between mild and severe degrees are most pronounced on the 5th day, in terms of blood flow of the superior mesenteric, gastroduodenal, hepatic and spleen arteries. Both groups of patients with mild and severe severity of acute pancreatitis (except for the superior mesenteric and splenic artery) differ significantly from the control group, but by the 5^th day, hemodynamic parameters with mild severity often approach control.
Discussion. Hemodynamic disorders in pancreatitis can manifest as changes in blood flow velocity, an increase or decrease in vascular diameter, as well as the appearance of signs of thrombosis or embolism. These changes can be detected using ultrasound examination methods such as CDK.
Conclusion. The greatest changes are recorded in vessels anatomically close to the affected area (gastroduodenal, hepatic arteries). Time dynamics: with a mild degree of OP – rapid normalization of indicators by the 5th day; in severe OP – persistent disorders indicating the incompleteness of the inflammatory process. Maintenance of elevated CPC values by day 5 may serve as an early marker of adverse course and risk of complications.

Introduction. Inguinal hernias are the most common pathology of the anterior abdominal wall (accounting for up to 80 % of all hernias). Total extraperitoneal (TEР) hernia repair is the "gold standard" of endoscopic treatment; however, the traditional technique using a balloon dissector is associated with a risk of peritoneal perforation and hematomas.
Purpose of the study. To improve surgical outcomes in patients with inguinal hernias using a modernized TEР hernia repair technique (RU Patent no 2626556) compared to traditional TEР.
Materials and methods. A prospective, randomized, controlled trial (2018–2025, n=112) was conducted. Inclusion criteria: primary inguinal hernias EHS P0–2, L, M (18–75 years, ASA I–III). Randomization was 1:1. Group 1 (n=56) – traditional TEР repair with a balloon dissector. Group 2 (n=56) – TEР-OR (RU Patent no 2626556). The following parameters were assessed: operative time, complications (Clavien-Dindo), length of hospital stay, quality of life (EQ-5D), and learning curve.
Results and discussion. The groups were comparable (p>0,05). The operative time in the TEР-OR group was 44,2 ± 4,1 min versus 64,7 ± 5,3 min (p<0,001). Intraoperative complications: 0% versus 5,4 % (p=0.041). Hematomas: 3,6 % versus 19,6 % (p=0,012). Acute urinary retention: 1,8 % versus 8,9 % (p=0,045). Length of hospital stay: 5,2±1,1 days versus 8,6 ± 1,4 days (p<0,001). Quality of life (EQ-5D): 0,91 ± 0,04 vs. 0,89±0,05 (p=0,21). Learning curve: stabilization after 12–14 surgeries. The results are comparable with literature data on eTEP and robotic TEР.
Conclusion. The modernized TEР hernioplasty (RU Patent No. 2626556) significantly reduces operative time, the incidence of intraoperative complications, hematomas, urinary retention, and the length of hospital stay. The method is safe, reproducible, and recommended for widespread implementation. A detailed analysis of quality of life and long-term complications will be presented in a subsequent publication.

Introduction. Chronic postoperative pain (CPP) after hernia repair occurs in 10–40 % of patients and remains an unresolved problem. Traditional total extraperitoneal (TEP) hernia repair with a balloon dissector can cause excessive tissue trauma and nerve damage, increasing the risk of CPP.
Objective: To compare the incidence and severity of CPP after traditional TEP and the modernized TEP-OR (RU Patent no 2626556).
Methods: A prospective, randomized, controlled trial (2018–2023, n=112) was conducted in patients aged 18–75 years with primary inguinal hernias (ESH P0–2, L, M (ASA I–III). Randomization was 1:1: Group 1 (n=56) – traditional THR with a dissector balloon; Group 2 (n=56) – the modernized THR-OR (RU Patent no 2626556). Chronic renal failure (CRF) was assessed at 6 and 12 months using the NRS (≥3) and DN4 (≥4). Acute pain was assessed using the VAS on days 1, 3, and 7. Risk factors were identified using multivariable logistic regression.
Results. The groups were comparable (p>0,05). At 12 months, chronic renal failure (NRS ≥3) was recorded in 6 patients (10,7 %) in the traditional THR group and in 1 patient (1,8 %) in the THR-OR group (p=0,049). A neuropathic component (DN4 ≥4) was observed in 3 patients (5,4 %) in the control group and 0 in the TEP-OR group (p=0,041). VAS scores were lower in the TEP-OR group at all stages. According to multivariate analysis, independent risk factors for chronic renal failure were traditional TEP (OR 6,2; 95 % CI 1,2–32,5; p=0,038) and acute pain intensity on day 7 ≥3 points (OR 4,8; 95 % CI 1,1–21,3; p=0,032).
Conclusion. The modernized TEP-hernioplasty (RU Patent no 2626556) significantly reduces the incidence of chronic postoperative pain (from 10,7 % to 1,8 %) and completely eliminates the neuropathic component of pain.

Introduction. Large post-traumatic diaphragmatic defects remain a challenging problem in thoracic and abdominal surgery due to the variable clinical anatomy, risk of delayed diagnosis, and the decisive role of stable reconstruction in respiratory function and quality of life.
Aim. To compare long-term outcomes after surgical repair of large post-traumatic diaphragmatic defects depending on the mesh fixation technique.
Materials and methods. The comparative clinical study included 58 patients operated on for large post-traumatic diaphragmatic defects in 2018–2026. Group I (n=31) underwent repair using an original mesh fixation technique reinforced with a non-absorbable frame suture (RF patent no 2846270), whereas Group II (n=27) underwent repair using the reference technique with U-shaped mesh fixation sutures (RF patent no 2400153). Outcomes included recurrence, pain syndrome, pulmonary function tests, electromyography, and SF-36 quality of life. Statistical significance was set at p<0.05.
Results. No recurrences were registered in Group I during follow-up; in Group II recurrence developed in 5 patients (18,5 %) within 1–1,5 months after surgery. At 12 months, pain syndrome persisted in 6,45 % vs 33,3 % of patients, respectively (p<0,001). Intergroup comparison showed advantages of the original technique in FVC, % predicted FVC, and FEV1. The total increase in EMG amplitude in Group I exceeded that in Group II by 32,8 %. The integral SF-36 score at 12 months reached 713 points in Group I versus 554 points in Group II, with an identical baseline score of 356 points.
Conclusion. The original technique for repairing large post-traumatic diaphragmatic defects using a non-absorbable frame suture provides a more stable reconstruction and is associated with lower recurrence and pain rates as well as better respiratory, electromyographic, and quality-of-life outcomes

Introduction. Currently, the "open abdomen" technique is becoming the leading method of surgical treatment for severe secondary peritonitis complicated by intra-abdominal sepsis. This technique effectively solves the problem of reducing intra-abdominal pressure and abdominal decontamination. However, contrary to expectations, vacuum-assisted laparostomes alone do not solve one of the main surgical problems with peritonitis – the problem of intestinal decompression. Moreover, the therapeutic effect of an "open abdomen" is often limited exactly by the adequacy of intestinal decompression.
The purpose of the study. To analyze the effectiveness of various methods of intestinal decompression under conditions of an "open abdomen" in the treatment of severe secondary peritonitis complicated by abdominal sepsis.
Materials and methods of research. The results of treatment of 98 patients with secondary perforated peritonitis complicated by intra-abdominal sepsis, who used an "open abdomen" surgical strategy, were studied. All patients were divided into the main (58 cases with significant dilation of the small intestine) and control (40 cases with a small intestine diameter of up to 4 cm) groups. In the main group, subgroups were identified depending on the method of decompression of the small intestine: I – "long" nasointestinal intubation with a Miller-Abbott probe (21 patients), II – "short" decompression of the proximal 25–30 cm small intestine (18 patients), III – ileostomy (19 patients). The dependence of treatment results on the degree of expansion and methods of decompression of the small intestine was studied.
Results. Mortality in the main group (36,7 %) was significantly higher than in the control group (25 %). Primary fascial abdominal closure in the control group was significantly more often performed (70 % versus 34,5 %). In the main group, the best results were achieved in subgroup II ("short" decompression of the small intestine). A significant difference in treatment results in the subgroups of the main group was noted in the following indicators: unsatisfactory treatment results in subgroups I and II (71,4 % vs. 33,3 %, p <0.05). Good treatment results in subgroups I and II (19 % vs. 55,5 %, p <0,05).
Conclusion. abdominal sepsis, bowel decompression, entero-atmospheric fistula, fascial closure, frozen abdomen», «open abdomen», secondary peritonitis, vacuum-assisted laparostomy

Introduction. Postoperative ventral hernias (PVH) are a common and clinically significant complication of laparotomy performed as part of staged surgical care (SSC), leading to reduced quality of life, limited physical activity, and increased risk of acute complications, including incarceration. Management of large PVH represents a complex reconstructive challenge with high rates of recurrence and postoperative complications, which necessitates objective preoperative assessment of the functional integrity of the anterior abdominal wall. Contemporary imaging modalities (ultrasound, CT, MRI) adequately characterize the anatomy of the hernial defect but do not reflect the neuromuscular function of the myoaponeurotic complex. Needle concentric-electrode electromyography (EMG) provides quantitative assessment of spontaneous muscle activity and the state of motor units by analysis of amplitude and temporal characteristics of motor unit potentials (MUPs), and may be considered an additional tool for preoperative patient stratification.
The purpose of this study is to evaluate the diagnostic value of quantitative needle EMG parameters of the abdominal oblique muscles in patients with large postoperative ventral hernias by assessing spontaneous muscle activity, MUP amplitude and duration, performing turn amplitude analysis, and comparing results with those of individuals without anterior abdominal wall defects.
Material and methods. A comparative analysis of EMG parameters was performed in patients with PVH and in a control group without signs of hernia. Needle EMG was conducted using a concentric electrode with registration of MUPs from the right and left halves of the anterior abdominal wall; baseline recordings of neuromuscular activity at rest were obtained to assess muscle tone and spontaneous activity. MUP amplitude and duration were evaluated. The analysis included 88 measurements in the study group and 56 in the control group (amplitude and duration were informative in 79 and 49 measurements, respectively). For each parameter, median (Me) with interquartile range [Q1; Q3], mean (M), standard deviation (SD), standard error of the mean and coefficient of variation (Cv) were calculated. Between-group differences were assessed with the nonparametric Mann-Whitney U test; differences were considered significant at p < 0,05.
Research results and discussion. Patients with PVH were older than controls (Me 33 [24; 40] vs. 27 [25; 29] years; p < 0.001) and demonstrated greater age heterogeneity (Cv 34,0 % vs. 13.6%). MUP amplitude in the study group was significantly lower than in controls (Me 232 [166; 288] vs. 385 [306; 430] μV; p < 0,001), with pronounced variability (Cv 47,5 % vs. 28,2 %). MUP duration did not differ significantly between groups (Me 8,84 [8.02; 9,48] vs. 8,32 [7,76; 8,96] ms; p > 0,05) with comparable coefficients of variation (13,4 % and 11,5 %, respectively).
Conclusion. The principal quantitative EMG markers in large PVH are reduced MUP amplitude and increased amplitude variability, reflecting heterogeneity of the neuromuscular status of the anterior abdominal wall. MUP amplitude demonstrates greater diagnostic sensitivity than duration and may be used as an adjunctive criterion for preoperative assessment of anterior abdominal wall functional integrity. In patients with long-standing hernias, turn amplitude analysis reveals a myopathic-type reorganization of the neuromuscular apparatus.

Introduction. Laparoscopic cholecystectomy (LCE) is one of the most common operations in abdominal surgery and is recognized as the "gold standard" for the treatment of acute cholecystitis. However, like any surgical intervention, CCE is associated with the risk of intra- and postoperative complications. The frequency of iatrogenic damage to the extrahepatic bile ducts, including choledochus, according to the literature, reaches 4 %. In this regard, the development and introduction into clinical practice of advanced technologies and new methods of intraoperative imaging, such as fluorescence surgery using indocyanine green (ICG), is a priority in emergency abdominal surgery.
The purpose of this study is to evaluate the feasibility and clinical effectiveness of using fluorescent ICG cholangiography during laparoscopic cholecystectomy based on the analysis of immediate intra- and postoperative results.
Materials and methods. The study was of a retrospective comparative nature. The analysis included data from 80 patients operated on for acute calculous cholecystitis between September 2025 and January 2026 at the Botkin Moscow National Cancer Center. In order to evaluate in more detail the effectiveness of fluorescent ICG cholangiography, taking into account the known limitations of the method, the patients were divided into three groups. Group I (ICG standard, n = 30) – laparoscopic cholecystectomy using ICG cholangiography in patients without pronounced factors potentially reducing the effectiveness of fluorescence imaging. Group II (ICG limitations, n = 10) – laparoscopic cholecystectomy using ICG cholangiography in patients with a pronounced inflammatory process characterized by a thickening of the gallbladder wall of more than 5 mm according to ultrasound and/or body mass index (BMI) > 26 kg/m2. Group III (control, n = 40) – standard laparoscopic cholecystectomy without the use of fluorescent navigation.
Results. The analysis of the duration of surgical intervention revealed differences between the studied groups. The average duration of laparoscopic cholecystectomy in group I (ICG standard) was 68 ± 12 minutes, in group II (ICG restrictions) – 82 ± 15 minutes, while in the control group – 90 ± 18 minutes. The volume of intraoperative blood loss was minimal in group I (18 ± 8 ml), slightly higher in group II (30 ± 12 ml), and maximal in the control group (40 ± 15 ml). The differences between group I and the control group were statistically significant (p = 0,003).
Conclusions. The use of fluorescent ICG cholangiography in laparoscopic cholecystectomy is an effective and safe method of intraoperative navigation, which allows to improve the visualization of extrahepatic bile ducts and optimize the course of surgery.

Introduction. An increase in the number of cardiac surgeries performed from classical sternotomy access also leads to an increase in the number of postoperative complications, in particular, anterior sternomediasthenitis, followed by the development of chronic osteomyelitis of the sternum and ribs and instability of the sternum.
The purpose of the study. To consider preoperative examination of markers of bone metabolism and ultrasound densitometric parameters as predictors of complications of cardiac surgery, which will expand the indications for the use of minimally invasive approaches in cardiac surgery.
Materials and methods. The study included 89 patients who underwent cardiac surgery with a previous specific examination that revealed osteopenia and osteoporosis. All patients underwent ultrasound densitometry at two points before surgery: in the lower third of the right radius and in the lower third of the sternum. To assess the processes of bone remodeling and resorption, the degree of the bone isoenzyme alkaline phosphatase (CAP) and tartrate-resistant acid phosphatase (TRKF) was studied, and the contents of calcium and phosphorus in the blood serum were determined.
Results. As a result of the conducted densitometric study, signs of osteoporosis and osteopenia were revealed in patients. The study of the initial level of biochemical markers can be used to predict the process of bone remodeling during the formation of bone marrow after sternotomy and to suggest the possibility of complications. All patients with complications showed a decrease in densitometric parameters in the presence of complications. A bone tissue study was conducted in 32 patients with initial osteopenia and osteoporosis who agreed to take the drug Strontium ranelate (Bivalos) and Calcium-D3 Nicomed before surgery. The number of patients with osteopenia and osteoporosis of the sternum who received complex treatment with Bivalos and Calcium-D3 Nicomed in terms of markers of bone metabolism decreased from 35,4 % to 8,4 % when taking Bivalos and from 41,7 % to 20 % when taking Calcium-D3 Nicomed.
Discussion. Complications from postoperative wounds in cardiac surgery, especially when it comes to sternomediasthenitis, are often life-threatening or lead to permanent disability. Treatment of mediasthenitis, osteomyelitis of the sternum and ribs is lengthy and financially costly. In this regard, cardiac surgeons are increasingly trying to reduce the traumatic nature of the operation and resort to the use of mini-accesses. However, the decision on minimum access requires a balanced individual approach with clear indications.
Conclusion. Modern basic cardiac surgery is increasingly performed using mini-accesses, replacing the classic full median sternotomy. The study suggests using preoperative examination of patients, including ultrasound densitometry to detect osteopenia and osteoporosis and the determination of biochemical markers of osteosynthesis, to select surgical access. This will lead to an expansion of objective indications for the use of minimally invasive approaches, which will ultimately reduce postoperative complications. Preventive use of remodulators by patients in the studied patients allowed to reduce the percentage of postoperative complications.

Introduction. Traumatic pseudoaneurysms of the peripheral arteries may be associated with an arteriovenous fistula, impaired distal blood flow, a paravascular hematoma, and injury to the surrounding tissues. This clinical and anatomical heterogeneity complicates the selection of an appropriate surgical strategy.
Objective. To develop an algorithm for the differentiated selection of open, endovascular, and hybrid treatment modalities for traumatic pseudoaneurysms of the peripheral arteries and to evaluate the results of its clinical application.
Materials and methods. A single-center study with retrospective and prospective components was performed. The outcomes of 195 men aged 19–60 years who underwent surgery between 2022 and 2026 were analyzed. Isolated pseudoaneurysm was diagnosed in 110 patients, whereas 85 patients had a pseudoaneurysm associated with an arteriovenous fistula. Open surgery was performed in 75 patients, endovascular treatment in 60, and hybrid surgery in 60. Treatment selection was based on lesion location and morphology, distal arterial runoff, ischemia, infection, hematoma, and urgency of intervention.
Results. Technical success was achieved in 191 patients (97,9 %) and did not differ significantly between the treatment groups (p=0,829). No pseudoaneurysm recurrence was observed. Recurrent arteriovenous shunting occurred in 13 of 85 patients (15,3 %). Target or reconstructed vascular segment patency was 95,4 %, the limb salvage rate was 99,0 %, and mortality was 1,5 %.
Conclusion. The developed algorithm enables differentiated selection of open, endovascular, or hybrid treatment according to the clinical and anatomical characteristics of the lesion and provides a high technical success rate with comparable safety of the different surgical approaches

Introduction. Aortic homograft and pulmonary autograft (Ross procedure) are biological methods of aortic root replacement that do not require anticoagulant therapy; however, their use is limited by the risk of progressive graft dysfunction. Clinical predictors of such dysfunction remain insufficiently studied, and published data are often contradictory.
Objective. To identify clinical factors associated with progression of dysfunction of the aortic homograft and pulmonary autograft and to develop an algorithm for selecting the optimal surgical approach for aortic valve disease based on these factors.
Materials and methods. Patients with available long-term echocardiographic follow-up after aortic homograft implantation (n = 17) and the Ross procedure (n = 20) were analyzed. Patients were divided into subgroups according to the presence or absence of graft dysfunction progression. Intergroup comparisons were performed using the t-test/Mann–Whitney U test and Fisher’s exact test. The prognostic value of age was assessed using ROC analysis, and independent effects were evaluated using univariate logistic regression.
Results. In the homograft group, progression of dysfunction was observed in 8 of 17 patients (47,1 %) and was associated with younger age (43,5 ± 13,7 vs 58,2 ± 13,2 years; p = 0,043), coronary artery disease (37,5 % vs 0 %; p = 0,050), longer cardiopulmonary bypass time (190 ± 63 vs 141 ± 30 min; p = 0,016), and longer myocardial ischemia time (142 ± 11 vs 114 ± 25 min; p = 0,007). ROC analysis for age demonstrated AUC = 0,795 (95 % CI 0,576–1,000; p = 0,032), with an optimal cut-off value of 61,5 years (sensitivity 62,5 %, specificity 90,9 %). Univariate logistic regression showed OR = 1,249 (95 % CI 1,062–2,641; p < 0,001). In the pulmonary autograft group, progression of dysfunction was observed in 6 of 20 patients (30,0 %) and was associated with older age (61,2 ± 8,3 vs 40,5 ± 9,8 years; p = 0,001), chronic kidney disease (33,3 % vs 0 %; p = 0,026), tricuspid regurgitation ≥ grade 2 (83,3 % vs 21,4 %; p = 0,044), and previous cardiac surgery (33,3 % vs 0 %; p = 0,026). ROC analysis for age demonstrated AUC = 0,976 (95 % CI 0,920–1,000; p = 0,001), with a cut-off value of 49,5 years (sensitivity 100 %, specificity 85,7 %). Logistic regression did not reach statistical significance (p = 0,998) due to complete separation in a small sample.
Conclusion. Age is a statistically significant but directionally opposite predictor of graft dysfunction: younger age is associated with homograft dysfunction, whereas older age is associated with pulmonary autograft dysfunction. These findings allow formulation of a preliminary decision-making algorithm for selecting between homograft implantation and the Ross procedure, which requires prospective validation in larger cohorts.

Introduction. Factors determining the high risk of amputation in patients with diabetic foot syndrome include severe infection, the depth of the ulcer-necrotic process, and circulatory status. Diabetes mellitus affects both the main vessels (macroangiopathy) and the microcirculatory system (microangiopathy). Tissue hypoxia creates conditions for the formation of necroses, which subsequently become infected, developing into an ischemic ulcer. Characteristics of diabetic angiopathy include younger age, multisegmental, and bilateral lesions.
The purpose of the study. To assess the state of the vascular bed and blebbing of the plasma membrane of lymphocytes in neuroischemic and ischemic forms of diabetic foot syndrome (DFS) depending on the duration of the disease.
Materials and methods. A prospective study examined 150 patients with type 2 diabetes, including 50 with neuroischemic and ischemic forms of diabetes mellitus (60 %) and 20 men (40 %). The vascular status (using Doppler ultrasound of the lower extremity arteries), the degree of diabetes compensation (based on glycated hemoglobin levels), and the lymphocyte membrane status were assessed.
Research results and discussion. In 72 % of patients, complete occlusion of the tibial-foot segment was observed, and in 28 %, stenosis. The level of glycated hemoglobin was 10,3 [8,5; 14,3] %, indicating insufficient compensation of carbohydrate metabolism disorders. Total and terminal blebbing was 30,1 [25,4; 33,2] % and 15,8 [11,8; 18,4] %, which was 3 and 5 times higher, respectively, than the values in the control group. A high positive correlation was noted between the level of glycated hemoglobin and total (rS=0,72; p=0,001) and terminal (rS=0,78; p=0.001) blebbing of the lymphocyte membrane.
Conclusion. Given the high correlation between glycated hemoglobin and lymphocyte plasma membrane blebbing, elevated glycated hemoglobin levels can be used as a marker for the development of endothelial failure in neuroischemic and ischemic forms of diabetic foot syndrome. At the same time, the level of total and terminal blebbing can be considered a pathogenetic marker of macroangiopathy.

Introduction. Recurrent varicose veins after endovenous surgery are of great social and medical importance, having disabling consequences. The factors leading to the recurrence of varicose veins are difficult to identify and control. Therefore, it remains relevant to search for risk factors and develop recommendations for their prevention in order to reduce the frequency of their development in patients with IBD after endovenous surgery.
The purpose of this study is to develop measures to prevent recurrence of varicose veins of the lower extremities (VVLE) after endovenous surgeries and to evaluate their effectiveness in the long-term period.
Materials and methods. A retrospective analysis of 1,647 medical records and outpatient charts of patients with VVLE, who underwent endovenous surgery on the main trunks of the superficial veins, including additional treatment of tributaries, was conducted to identify recurrence of VVLE after surgery. In patients with recurrence, clinical and demographic data, instrumental and laboratory test results, drug therapy, and surgical intervention characteristics were studied in detail. Based on the identified factors, measures for the prevention of VVLE recurrence were developed, the effectiveness of which was studied in a separate prospective group of patients (n=60). The follow-up period for patients in the prospective group was 12 months. Data processing was performed using SPSS version 25 and Microsoft Excel.
Research results and discussion. The recurrence rate of VVLE among 1647 patients was 3,1 % (n=51). Recurrences manifested themselves both as
neoangiogenesis (56,7 %) and as true recurrent varicose veins (43,1 %). The most significant risk factors for recurrence VVLE after endovenous
surgery were: age over 65 years, BMI over 34 kg/m2, type 2 diabetes mellitus in the decompensation stage (with a glycated hemoglobin level above 8 %), II or higher functional class of heart failure (according to NYHA), functioning incompetent perforating veins of the thigh and leg; functioning tributaries on the thigh over 3 mm in diameter, on the lower leg – over 5 mm, the presence of a functioning anterior tributary of the great saphenous vein (GSV) over 3 mm in diameter, the Giacomini vein over 3,5 mm, the size of the residual stump of the GSV in the area of the saphenofemoral junction over 1 cm, the power of exposure up to 7 W and the fluence of the laser study less than 80 J/cm2, the diameter of the trunk of the GSV on the femur more than 8 mm. The proposed preventive measures, developed taking into account the identified risk factors, were based on the correction of drug therapy in order to compensate for diabetes and the functional class of CHF, BMI, as well as compliance with certain technical parameters for performing endovenous surgeries and processing additional tributaries. The use of the developed preventive measures made it possible to achieve high efficiency of endovenous interventions, which was reflected in the recurrence rate, which was 1,6 % by the 12th month of observation, among 60 patients in the prospective group.
Conclusions. The proposed measures for the prevention of recurrence of VVLE, influencing the identified modifiable clinical, instrumental, anatomical and surgical risk factors, demonstrated high efficiency in reducing the incidence of recurrence of VVLE after endovenous interventions on the saphenous veins of the lower extremities.

Introduction. Infectious endocarditis (IE) in people who inject drugs involves total destruction of the tricuspid valve (TV). The only radical solution is to replace him. Numerous studies show that such patients have a 19–28 % risk of early reinfection with the prosthesis, and repeat surgeries are highly lethal. The key to failure is not a surgeon’s technical errors, but continued drug use. In this paper, we describe a series of patients who developed recurrent IE after one-stage bioprosthetics of TV for twelve months – all of whom continued to use drugs and did not receive treatment for addiction.
The aim of this study is to assess the frequency, microbiological profile, and clinical outcomes of early (<12 months) infectious endocarditis (IE) recurrence after single-stage tricuspid valve (TV) bioprosthesis. in patients with confirmed continued intravenous drug use.
Materials and methods. Retrospective analysis of data for 2018–2025. Included patients with intravenous drug IE TV who underwent single-stage bioprosthetics and returned within 12 months with IE recurrence on the installed prosthesis. Confirmation of continued use was made from chemical and toxicological research, social history and medical history.
Results of the study and discussion. Retrospective analysis of 7 clinical cases with recurrence of infectious endocarditis, prosthetic tricuspiral valve and active intravenous drug use was performed.
Conclusion. Single-stage bioprosthetics of TV in active drug users carries a high risk of early reinfection and death. The two-stage treatment tactic of primary valvechtomy is a "bridge" to the recovery of the country’s young population.

Introduction. According to the latest data, breast cancer ranks first in the structure of female mortality in Russia, accounting for 22,4 % of all cases in 2023. The average age of diagnosis of the disease is 64,3 years, while the incidence is increasing annually by an average of 1,51 %. Due to progress in early diagnosis, systemic therapy, and standard postoperative radiation therapy (LT), the widespread use of organ-preserving surgery for operable breast cancer has become possible.
The aim of the study was to evaluate the effectiveness of intraoperative mammography to determine the nearest edge of resection during organ-preserving operations in patients with early breast cancer.
Materials and methods. A single-center, cohort prospective study was conducted to analyze the immediate results of radical surgical treatment with the determination of resection margins during organ-preserving operations in patients with early breast cancer (cT1–2N0–1). Preoperative marker needle marking was performed in 15 patients (12 in the main (20 %) and 3 (8 %) in the control group). The breast sector was placed on a pre-prepared sheet of white paper with markings: "top", "bottom", "lateral" and "medial", separately for the left and right mammary glands, then an X-ray image was taken on a digital mammograph.
Results. In the main group, in all 60 patients, the nearest edge of breast resection was determined using digital mammography – in 100 % of cases, this was also the case during pathomorphological examination. In 8 patients (13,3 %), a "positive" resection margin (R1) was detected. R1 was distributed depending on the size of the tumor node: 2 cases were 0,5 to 1 cm in size, 5 cases were 1 to 2 cm in size, and 1 case was more than 2 cm in size. R1 was more common in the outer quadrants (6 episodes); 1 in the central and 1 in the upper-inner quadrants. In 4 patients, the positive resection margin was found in the lower quadrant and medial breast. In the control group, a positive resection margin (R1) was detected in 8 patients (20 %): 1 patient with a tumor up to 0,5 cm, 3 patients with a tumor node size from 0,5 to 1 cm, 4 patients with a tumor node size from 1 to 2 cm, and 1 patient with a tumor node size of more than 2 cm.
Discussion. Intraoperative X-ray examination of the edges of breast resection in early cancer is a relatively new method that is currently not included in the clinical recommendations of the Russian Ministry of Health, but its simplicity and high diagnostic effectiveness will soon make it possible, together with pathohistological examination, to become the main diagnostic methods for controlling the radicality of breast cancer surgery. It is also worth noting that this technique is the only one capable of determining the removal of X-ray contrast interstitial markers installed before the CT scan
Conclusion. The results of a prospective non-randomized study showed that the inclusion of X-ray examination (“specific mammography”) as a stage of intraoperative diagnosis to assess the status of the edges of breast resection for early cancer effectively and quickly determines the edge of resection closest to the tumor

Introduction. Ileotransverse anastomotic leakage after right hemicolectomy remains one of the most clinically significant complications in colorectal surgery and is associated with a complicated postoperative course.
Objective: to assess the incidence of ileotransverse anastomotic leakage and to identify risk factors for its development after right or extended right hemicolectomy.
Materials and methods: A retrospective cohort study included 417 patients operated on between January 30, 2019 and April 24, 2026. Clinical, laboratory, tumor-related and intraoperative variables were analyzed. Independent risk factors were assessed using Firth logistic regression.
Results. Anastomotic leakage occurred in 19 of 417 patients (4,6 %). Among patients with leakage, Clavien-Dindo grade ≥IIIa complications occurred in 84,2 %, reoperation and stoma formation in 68,4 %, and death in 47,4 %. In the multivariable model, ECOG ≥2 (aOR 5,71; 95 % CI 1,89–17,21), neutrophil-to-lymphocyte ratio (aOR 2,12 per 1 unit; 95 % CI 1,60–2,81), blood loss (aOR 1,60 per 50 mL; 95 % CI 1,02–2,51), and anastomotic technique remained independently associated with leakage. A reinforced stapled anastomosis was associated with a lower probability of leakage compared with a non-reinforced stapled anastomosis (aOR 0,04; 95 % CI 0,002–0,84). The model AUC was 0,927.
Conclusion. The risk of ileotransverse anastomotic leakage is multifactorial and is associated with patient functional status, systemic inflammatory response, intraoperative blood loss and technical features of anastomosis formation.

Introduction. Purpose: to study the number and features of the development of extraperitoneal complications of gunshot wounds to the abdomen with bullet and shrapnel wounds.
Materials and methods. A retrospective study, to achieve this goal, a study was conducted of 30 civilian patients who were treated for gunshot wounds to the abdomen. All patients were divided into two groups depending on the nature of the wound: 15 (50 %) people received bullet wounds, 15 (50 %) – shrapnel wounds.
Results. The study shows that the development of extraperitoneal complications in gunshot wounds of the abdomen during the phase of subsiding peritonitis was recorded in 60 % of observations, while the predominance of these complications was noted in the group with bullet wounds – 40 %, while in the group with shrapnel wounds such complications were noted in 20 % of observations. Complications associated with damage to the cardiovascular system and kidneys came to the fore – 20 % of observations, in the second – the respiratory system (pneumonia) – 3,4 %. At the same time, complications associated with the involvement of the cardiovascular system came to the fore in cases of bullet injury – 16,7 % of cases, while with shrapnel wounds such complications developed only in 3,3 % of observations. The same trend was noted when the excretory system and respiratory system were involved in the pathological process, the development of complications from these systems was also more often observed with bullet wounds.
Conclusion. Extra-abdominal complications in gunshot wounds of the abdomen in the phase of subsiding peritonitis occur in 60 % of cases. The number of complications depends on the nature of the injury, and is most often recorded in bullet wounds.

Introduction. Restoring the shape of the abdomen after childbirth is becoming an increasingly urgent issue every year. Given the increasing age of women in labor and the appearance of a significant number of multiple pregnancies, it should be noted that it is impossible to restore the shape of the anterior abdominal wall by therapeutic methods. In addition, abdominoptosis after pregnancy is usually combined with an umbilical hernia (or with an extension of the umbilical ring) and with diastasis of the rectus abdominis muscles. The issue of reconstruction of the anterior abdominal wall after cesarean section requires separate consideration. The presence of a scar after a previous operation requires its excision, which can cause skin tension during abdominoplasty. Simultaneous surgical treatment of an umbilical hernia during abdominoplasty is associated with a violation of the blood supply to the skin in the navel area.
The aim of the study was to compare the immediate and long-term results of abdominoplasty and umbilicoplasty in patients after pregnancy with natural delivery and cesarean delivery.
Materials and methods. The study included 72 patients who underwent abdominoplasty surgery in combination with rectus abdominis diastasis and umbilicoplasty in the period 2023-2025. All patients underwent classical abdominoplasty in combination with diastasis of the rectus abdominis and umbilicoplasty. The question of the navel dislocation was considered individually.
Results. During the study, an assessment of complications in the immediate and long-term (after 3 and 6 months) postoperative period was performed. The total number of complications in both groups was 13 (18.1%). At the same time, the number of complications was twice as high among patients who underwent cesarean section. The descriptions of two clinical cases are presented as an illustration.
Discussion. Despite the low degree of abdominoptosis, patients in the postpartum period have a combined violation of the structure of the anterior abdominal wall. In patients who underwent cesarean section, the condition is aggravated by the presence of a postoperative scar.
Conclusion. Combined abdominal and umbilicoplasty operations are the operations of choice for restoring the shape of the abdomen in patients after pregnancy. The results, both immediate and long-term, are better in patients with a natural birth process than in patients with a cesarean section. Attempts to minimize the volume of the operation and, as a result, the number of complications can lead to an unsatisfactory aesthetic result of the operation.

Background. After reconstructive lipoabdominoplasty, the most common local complications are seromas, hematomas, and wound infections. One factor that can influence the early postoperative period is the tissue electrodissection mode.
Study objective. To compare the early results of reconstructive lipoabdominoplasty using monopolar coagulation, monopolar cutting, and the Valleylab mode.
Materials and methods. A prospective comparative study of 90 patients after reconstructive lipoabdominoplasty was performed. Three groups of 30 patients were formed depending on the electrodissection mode. The length of hospital stay, the incidence of seromas, hematomas, infectious complications, and reinterventions were assessed. Complications were classified using the Clavien-Dindo scale.
Results. The Valleylab group had the shortest hospital stay – 5,07±1,11 days. Seromas were reported in 20,0 % of patients in the monopolar coagulation group, 23,33 % in the monopolar cutting group, and 6,67 % in the Valleylab group. The incidence of hematomas was 16,67 %, 10,0 %, and 3,33 %, respectively. Despite a lower incidence of these complications in the Valleylab group, no statistically significant differences were observed between the groups. No Clavien-Dindo grade IV complications were observed.
Conclusion. The Valleylab regimen is associated with a more favorable early postoperative course after reconstructive lipoabdominoplasty. In absolute terms, this group also had lower rates of seromas, hematomas, and reoperations.

Introduction. Diabetic foot syndrome (DFS) remains the leading cause of high lower limb amputations in patients with diabetes mellitus (DM). The neuropathic form of DFS is characterized by a triad of pathogenetic factors: severe bacterial contamination, tissue hypoxia, and growth factor deficiency, which requires the development of new comprehensive, pathogenetically oriented approaches to local wound treatment.
Purpose of the study. To evaluate the effectiveness of the developed comprehensive approach in the local treatment of purulent-necrotic wounds in the neuropathic form of DFS.
Materials and methods. A prospective study included 20 patients (the main group – 10 people, the comparison group – 10 people). The study included patients with purulent-necrotic soft tissue wounds of the neuropathic form of DFS 1–3 degrees of damage according to the Wagner scale. In the main group, a three-stage approach was used: UBL-001-AMS (pulsating mode, 20 min/day), local O2 supply (5 L/min, 10 min/day), and injection-application of PRP. In the comparison group, standard ointment dressings were used. The effectiveness of treatment was assessed based on cytological, histological, microbiological, and RAN.PRO mobile planimetry data on days 1, 3, 7, and 11.
Results. In the main group, there was a statistically significant acceleration of wound rehabilitation (a decrease in CFU/g to the threshold value by day 7 in 80 % of patients versus 20 % in the comparison group, p <0,05); a decrease in the duration of hospitalization by 29,4 %, 11,5±1,7 vs 16,3±2,8 bed days; absence of high amputations There were 2 cases in the main group versus the comparison group (20 %), p <0,05). Morphological assessment confirmed accelerated granulation tissue formation and angiogenesis in the main group, while exudative-inflammatory changes prevailed in the comparison group.
Conclusion. The developed pathogenetically substantiated approach provides a comprehensive effect on all stages of the wound healing process, significantly accelerates tissue repair, and reduces the frequency of radical surgeries involving high amputations.

Introduction. Extended pelvic lymph node dissection is a standard treatment for pelvic malignancies. Small bowel obstruction due to internal hernia beneath external iliac artery or pelvic fascia is a specific complication after pelvic lymph node dissection and is extremely rare. First, internal herniation of small bowel was described in 1978 year, and all over the world that has only been reported in 17 cases in previous English-language literature.
Methods. In the Moscow multidisciplinary scientific clinical center. S.P. Botkin, surgical intervention was performed regarding the internal infringement of the loop of the small intestine in a defect after RTLAE, between the left external and internal iliac arteries, in a man of 57 years old.
Results. We reported a case of 57-year-old man with acute strangulated internal hernia between the left external and internal iliac arteries as late complication of robotic prostatectomy with pelvic lymph node dissection. The patient was admitted to our hospital with chief complaints on nausea and abdominal pain. Due to findings of small bowel ischemia of contrast-enhanced computed tomography (CT), the emergency laparotomy was performed. Intraoperative findings showed internal herniation of the small bowel through an orifice of the left external and internal iliac arteries. The incarcerated small bowel was necrotic with bowel obstruction. Surgical procedure was divided into 2 stages in conception of “second look” strategy. The incarcerated small bowel was resected and decompressed. At the second surgical procedure a side-to-side anastomosis with closure of internal hernia between iliac arteries using fat suspensions of the sigmoid colon was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 6.
Conclusion. Internal gerniation with small bowel strangulation beneath pelvic vessels and fascia is a rare and specific complication after pelvic lymph node dissection. When this complication is suspected, we recommend to distinguish it from adhesive ileus and perform an emergency operation promptly with accurate vessel dissection and closure of peritoneal fissure to prevent recurrence internal gerniation.

Introduction. Recurrent achalasia after primary surgical treatment remains a challenging problem, especially in the presence of severe fibrotic and adhesive changes in the esophagogastric junction area. Radical resection procedures are associated with high surgical trauma and significant postoperative morbidity, which determines the relevance of organ-preserving minimally invasive approaches.
Aim. To demonstrate the efficacy of laparoscopic redo cardiomyotomy with antireflux fundoplication for recurrent achalasia after Petrovsky esophagophrenoplasty.
Materials and methods. We present a clinical case of recurrent stage IV achalasia with sigmoid-shaped esophageal deformity. The preoperative Eckardt score was 12 points. Laparoscopic redo cardiomyotomy with fundoplication was performed.
Results. Operative time was 265 minutes, and blood loss was 100 mL. No intraoperative complications were observed, including esophageal mucosal injury. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. At 6-month follow-up, the Eckardt score decreased to 2 points, while the GERD-Q score was 2 points. No signs of recurrence were observed after 1 year.
Conclusion. The presented case demonstrates that laparoscopic redo cardiomyotomy with fundoplication is considered an effective and safe option for recurrent achalasia.

Introduction. Chronic venous disease (CVD) is a highly prevalent and progressive condition affecting 60–80 % of the adult population worldwide, with particularly high rates reported in Russia. Despite its significant socioeconomic burden – including direct healthcare costs exceeding 1–3 % of total health expenditure and comparable indirect productivity losses – CVD remains underdiagnosed in routine clinical practice. This narrative review systematizes current evidence on epidemiology, risk factors, pathogenesis, clinical presentation, diagnostic approaches, treatment strategies, and determinants of patient adherence in CVD, based on 30 sources selected from 53 publications identified over the past 15 years in Web of Science, PubMed, Scopus, and Google Scholar.
The main part. Chronic venous hypertension is the central pathogenetic mechanism, triggering endothelial activation, leukocyte adhesion, release of proteolytic enzymes, and a self-perpetuating inflammatory cascade culminating in skin trophic changes and venous ulceration. The CEAP classification and Venous Clinical Severity Score remain the cornerstones of patient stratification and outcome monitoring. First-line management includes compression therapy and venoactive pharmacotherapy; endovenous thermal ablation has replaced open surgery as the standard interventional approach, while cyanoacrylate embolization represents a promising non-thermal alternative. Adherence to therapy is shaped by physical, financial, and psychological barriers, with self-efficacy identified as a key protective factor.
Conclusion. An integrative approach combining early diagnosis, individualized treatment, and targeted adherence interventions substantially improves clinical outcomes, particularly in elderly patients, pregnant women, and those with comorbid conditions.

Introduction. The treatment of extensive purulent-necrotic wounds remains one of the most challenging problems in contemporary surgery. Even after thorough debridement of the wound surface, significant difficulties arise, including substantial plasma loss, poor granulation tissue formation, and insufficient autologous tissue for reconstruction. The inability to achieve wound closure leads to frequent painful dress changes and the development of secondary complications. Over the past decades, negative pressure wound therapy (NPWT) has established itself as an effective modality through its capacity to remove exudate, reduce microbial burden, stimulate granulation tissue growth, and enhance local tissue perfusion. In parallel, approaches to controlled tissue expansion and combined wound closure techniques have continued to evolve.
Objective. To systematize patent developments and available literature data on treatment methods for complicated wounds using NPWT and combined technologies over a 25-year period (2000–2024).
Results. The evolution of combined approaches integrating NPWT systems with dermotension, irrigation, and controlled distraction has been characterized. Contemporary methods are aimed at guided wound healing and minimization of procedural trauma.
Conclusion. Current approaches are defined by a transition toward integrated systems combining mechanical, physical, and biological interventions. A particularly promising direction is the development of adaptive complexes capable of dynamically managing all stages of the wound healing process, which holds the potential to substantially improve treatment outcomes and patient quality of life.

Objective. Comparative assessment of mortality after completion pancreatectomy and pancreas-sparing techniques in the treatment of patients with pancreatic fistula after pancreaticoduodenectomy
Materials and methods. The systematic review and meta-analysis were carried out in accordance with the recommendations of the Federal State Budgetary Institution Center for Evaluation and Evaluation of the Ministry of Health of the Russian Federation and the section of the Cochrane Community Guidelines governing the meta-analysis of non-randomized trials. Searches were carried out in Russian and English in e-library, CyberLeninka, Google Scholar, Cochrane Collaboration Library and PubMed for 1990–2025. The table of contents of specialized journals and secondary links of thematic review articles were reviewed. Statistical calculations were carried out in RevMan 5.4. Among the studies, high heterogeneity (I2=27 %) was noted, and therefore a random effects model was used.
Results. A systematic review of randomized trials comparing mortality in completion pancreatectomy and pancreas-sparing techniques for pancreatic fistula did not find any evidence in the available literature. Meta-analysis based on available published data from non-randomized trials. Searches identified 186 studies of which 39 papers met the inclusion criteria. The final meta-analysis included the results of treatment of 2207 patients, 821 (37,2 %) of whom underwent completion pancreatectomy, and in 1386 (62,8 %) cases, pancreas-preserving techniques were used. Patients after completion pancreatectomy had a higher chance of death, odds ratio 1,79 [9 5% CI = 1,21–2,64]
Conclusion. Completion pancreatectomy statistically significantly increased the chance of death in patients with pancreatic fistula after pancreaticoduodenectomy. At the same time, the high level of heterogeneity of the studies and the lack of randomization create a risk of bias. Further study of the consequences of using different tactics in pancreatic fistula after pancreaticoduodenectomy is needed.

Introduction. Modern armed conflicts, in particular the Special Military Operation, are characterized by a high proportion of mine-explosive and shrapnel wounds to the head and face. The key problem of reconstructive surgery of the maxillofacial region in these conditions is the choice of the optimal plastic material. Requirements for the ideal method: high engraftability, minimum surgery time. The main part. The work is devoted to the review and comparison of five modern methods of facial plastic surgery, which are used to treat mine-explosive and gunshot wounds in conditions of their own.
Conclusion. Despite the high engraftability of free flaps, the gain in functional adaptation time and a fundamentally different complication profile make local rotational techniques an absolute priority for the treatment of mine-blast wounds of the face in conditions of ITS own. Free flaps should be considered only if the local vascular structures of the face are completely destroyed or if it is necessary to replace extensive bone defects when the rotational possibilities are exhausted.

Large ventral incisional hernias (VIH) with loss of domain (LOD) present major challenges in reconstructive surgery. Accurate classification and risk stratification are essential to reduce complications and recurrence.
Methods. This review synthesizes current evidence on managing large VIH (width ≥10 cm, EHS W3). It analyzes classification systems (EHS, VHWG, CeDAR), preoperative preparation (risk factor modification, botulinum toxin type A [BTA], progressive pneumoperitoneum [PPP]), surgical techniques (mesh positioning, component separation), and the Tanaka Index (TI)-based treatment algorithm.
Results. BTA enables chemical separation, reduces closure tension, and lowers complication rates (RR 0.66) but does not significantly affect recurrence. PPP expands abdominal cavity volume, reducing abdominal compartment syndrome risk. For severe LOD (TI >0,35), combined BTA+PPP is recommended. Retromuscular sublay and transversus abdominis release (TAR) are the gold standard for large midline defects, offering lower wound morbidity than anterior component separation. Proposed algorithm: TI <0,25 → standard reconstruction (TAR optional); TI 0,25–0,35 → preoperative BTA with selective PPP; TI >0,35 → BTA+PPP followed by TAR.
Conclusion. Modern management of large VIH requires a personalized, multidisciplinary approach: precise classification, preoperative optimization (BTA, PPP when indicated), and retromuscular mesh placement with adequate defect coverage. TAR is the preferred technique for large midline hernias

Introduction. Hemorrhoidal disease is one of the most common reasons for referral to a coloproctologist. Surgical treatment includes both traditional methods (Milligan–Morgan hemorrhoidectomy) and modern minimally invasive interventions (laser hemorrhoidoplasty, HAL-RAR, Longo operation). The incidence of clinically significant postoperative bleeding ranges from 0,5 % to 3 %, with massive bleeding occurring in 0,1–1 % of cases.
Purpose. To systematize current data (with an emphasis on meta-analyses of the last 5 years) on rare causes of hemorrhagic complications after various methods of surgical treatment of hemorrhoidal disease, and to present an algorithm for their diagnosis and prevention.
Materials and methods. An analysis of publications for 2019–2026, including meta-analyses, systematic reviews and clinical cases, was carried out. Search sources — PubMed, Cochrane Library, eLibrary.ru.
Results and discussion. Rare causes of postoperative bleeding are considered: coagulopathies (factor V deficiency, von Willebrand disease, acquired hemophilia), vascular anomalies (Dieulafoy syndrome, angiodysplasia), aortoenteric fistulas, anorectal varices in portal hypertension, colorectal cancer. Frequency, clinical manifestation and diagnostic criteria are presented. A step-by-step diagnostic algorithm (hemodynamic assessment, revision, laboratory and instrumental search) and treatment tactics taking into account the identified cause are proposed.
Conclusion. Rare causes of hemorrhagic complications require high clinical alertness. Key elements of prevention are preoperative screening for coagulopathies, management of antithrombotic therapy, and colonoscopy in at-risk patients.

Introduction. Infectious endocarditis (IE) - a dangerous complication of intravenous drug use. In this group of patients, ME is usually affected by the tricuspid valve (TC) and is characterized by an aggressive, relapsing current. Classical conservative antibiotic therapy is often ineffective in cases of extensive vegetations, abscesses and septic complications such as pneumonia. In such cases, surgery becomes the only chance to save lives.
Main part. A feature of ME in injecting drug users is the combination of several factors that significantly complicate treatment and prognosis:
• Aggressive course: The disease progresses rapidly, often leading to severe complications such as heart failure, sepsis and death.
• TC failure: Unlike ME in non-drug-dependent patients, who are more likely to have a mitral or aortic valve, TC is most prevalent in drug users.
• Relapses: Long-term drug use and low commitment to treatment contribute to frequent relapses, even after successful surgery.
• Related diseases: Drug addicts often suffer from related infections, immunodeficiency states, which worsen the course of IR and reduce the effectiveness of treatment.
• Asocial lifestyle: Difficulties in maintaining treatment regimen, lack of social connections and support complicate postoperative rehabilitation.
Direct TC prosthetics at the first intervention in drug users carries a high risk of infection recurrence due to continued use of injectable drugs after surgery. Reconstructive operations on TC are often ineffective and lead to a rapid return of tricuspid regurgitation.
In view of the above challenges, a two-stage surgical approach to ET TK treatment for drug users has been developed:
Stage 1: Resection and sanitisation. This stage involves the resection of the infected TC with a thorough sanification of the right heart sections. All infected tissue including vegetation and surrounding affected structures is removed. It is important to achieve complete removal of the infection site to prevent relapses. No TC prosthetics at this stage to minimize the risk of reinfection. The patient is given intensive antibacterial treatment.
Stage 2: Delayed prosthetics. After a few weeks or months, once the infection is fully diagnosed and the patient’s condition has stabilized, TC prostheses are performed with a biological prosthesis. Biological prostheses are preferable because of the lower risk of thrombosis and infection, which is especially important in patients with impaired blood coagulation.
The conflicting results of existing observations and the lack of agreement on many aspects concerning the prosthetics of a tricuspid valve in intravenous drug users, Prevent a final decision on the best treatment and require randomized studies in this area.
Conclusion. Treating intravenous drug users with ET TK is a complex task that requires a comprehensive approach. The two-stage surgical strategy, which involves removing an infected valve followed by delayed prosthetics, is the most promising method for achieving long-term remission. However, the success of treatment depends in large part on close collaboration between surgeons, infectionists, drug addicts, and the patient’s own social support aimed at overcoming risk factors for relapse and increasing commitment to treatment.