Objective: To improve the results of treatment of patients with complicated forms of chronic pancreatitis Material and method: The experience of the successful application of hybrid minimally invasive technologies in a patient suffering from chronic pancreatitis complicated by the splenic artery pseudo-aneurysm and pancreatic head pseudocysts is described. Results: In a patient with pseudo-aneurysm of the splenic artery and pseudocystic pancreas, successful endovascular embolization of the splenic artery was performed at the first stage. At the second stage, after 7 days of the patient endoscopic formation of cystogastroanastomosis was performed. The patient was discharged on the 12th day from the moment of admission to the hospital. Conclusion: The use of minimally invasive technologies makes it possible to improve the results of treatment of patients with complicated forms of chronic pancreatitis.

The purpose of a single-center retrospective study: to identify risk factors that contribute to the ineffective drainage of the biliary tract during antegrade stenting uncovered by self-expanding vzbo stent. In the surgical clinic of the Botkin Hospital (Moscow) for the period from 2009 to 2017. Stenting was performed in 54 patients with VzBO. The average age was 73.2 ± 5.3 years; the average level of bilirubinemia - 294.2 ± 10.1 µmol / l; VzBO level: Bismuth II - 11, Bismuth III - 43; comorbid background: associated cholangitis - 9 (16.7%); concomitant cirrhosis - 7 (12.9%). 28 had side-by-side stenting, 15 Y-stenting, 11 stenting of the common hepatic duct with one stent. The causes of zVBO were: portal cholangiocarcinoma 23 (42.6%), intrahepatic cholangiocarcinoma 16 (29.6%), gallbladder cancer 9 (16.7%), metastatic cancer 6 (11.1%). Univariate analysis revealed significant factors contributing to ineffective drainage in the form of bilirubinemia before stenting (p = 0.028), comorbid cholangitis (p = 0.036), Y-stenting (p = 0.032) and single stenting (p= 0.047). Age, gender and Bismuth classification type were not significant factors affecting ineffective drainage.

The article presents the results of using endoscopic transluminal pancreatic necrosectomy in patients with diagnosed infected necrotizing pancreatitis. Moreover, clarification of the endoscopic transluminal pancreatic necrosectomy’s use and its technique has been described. There have been made conclusions about the value of this minimally invasive method.

The analysis of the treatment outcomes of 358 patients with an inguinal hernia, treated surgically from 2015 to 1016 in the department of surgery №17 of Municipal Clinical Hospital named after S.P. Botkin, has been conducted. Among them there were 320 men (89,4%) and 38 women (10,6%). An average age of the patients was 51,6±17,3 years. 9 (2,5%) patients presented with a recurrent inguinal hernia. Inguinal canal repair (according to the Lichtenstein technique) was performed in 233 patients (65,1%, the first group), and laparoscopic hernioplasty (TAPP) was performed in 125 patients (34,9%, the second group). The diagnosis in the course of comparative analysis was formulated according to the NYHUS L.M. (1993) classification with the purpose of the data unification. Statistical groups had no significant differences in gender, age, or type of hernia according to the degree of complexity.Statistically significant differences in indices were not revealed in the course of analysis of the shirt-term results in the two compared groups. For the purpose of the investigation of the long-term results we have analyzed the cases of a recurrent hernia, as the main aspect. We have also conducted a testing with the use of the Short-Form Health Survey MOS SF-36 to take an assessment of the life quality of the patients, who were operated on for inguinal hernia. In the group of patients after the TAPP repair stabilization of indices of physical and psychological components was observed at 6 month after the surgery. In the group of patients after the inguinal canal repair (according to the Lichtenstein technique) stabilization was observed within a year after the surgery. During the second year of monitoring and assessment there were no significant changes in the both groups. In conclusion, the both methods of tension-free hernioplasty can be considered as similarly effective and reliable techniques for the surgical treatment of inguinal hernia. These methods can be also characterized by the minimal amount of postoperative complications and recurrences. Recovery of physical and psychological components of health in the postoperative period of TAPP occurs earlier than in the postoperative period of inguinal canal repair according to the Lichtenstein technique. Stabilization of physical and psychological components of health during the postoperative period occurred earlier in patients of a younger age than in elderly and senile patients. This is connected with the presence of concomitant somatic diseases that reduce physical activity and psychoemotional background in this category of patients.

In this study were the results of application of the first real-time laser confocal microscopy in intraoperative study at various thyroid nodules. The study was conducted in 34 patients aged from 24 to 55 years. Among them were 20 (58.8%) patients with nontoxic multinodular goiter, 8 (23.5%) - with thyroid adenoma and 6 (17.6%) patients with thyroid carcinoma.

The article presents a clinical example of a good result of surgical treatment and anticoagulant therapy of a patient with left kidney cancer and cancer associated thrombosis of the hollow vena cava. The presence of an active oncological process in surgical interventions performed even in a normal volume increases the risk of thrombotic complications by more than 3 times. We give an example of medical tactics on the example of our clinical case.

Background: Laparoscopic and robotic arcuate ligament release has been demonstrated a good therapeutic option for arcuate ligamentsyndrome. Methods. Clinical and surgical data and short- and long-term outcomes together with the impact of the degree of stenosis of the celiac trunk were analyzed in 5 patients who underwent laparoscopic and robotic arcuate ligament release between 2014 and 2017. Results: Five patients (4 F/1 M) underwent surgery. The median age was years old, and their mean body mass index was 18.9 (range 14.7-25). All of the 5 patients presented with intense postprandial abdominal pain associated with weight loss. The median duration of symptoms was 24 months (range 2-240). Median operative time was 101 min (range 83-134), and there was one conversion to open surgery. Median hospital stay was 3 days (range 2-14). Over a median follow-up of 12 months, five patients had excellent results after surgery. One patient experienced worth outcome. Conclusion: Laparoscopic and robotic arcuate ligament release constitutes an excellent treatment for arcuate ligament syndrome.

The present research aims at a retrospective evaluation of the intraskin and endoscopic chronic pancreatitis treatment methods complicated by pseudocysts of the pancreas. In the period between 2008 until August 2018 Botkin city clinical hospital admitted 481 patients with chronic pancreatitis. The progression of the pancreatitis in 124 (32.6 %) patients was complicated by appearance of postnecrotic pseudocysts of the pancreas. Intraskin method of treatment was applied for 29 patients. endoscopic invasions (making cystogastro/cystoduodenostomosis under endosonographic guidance) were performed for 45 patients. Dynamic watch was maintained for 14 patients with symptomless pseudocysts of the pancreas less than 5 cm in size. The remaining 36 patients underwent different resecting and draining procedures. Throughout the period a recurrence of a pseudocyst was recorded in three patients after performing cystogastroanastomosis under endosonographic guidance, and in 7 - after intraskin drainings. The analysis of short-term and long-term treatment results alongside with evaluation of the patients’ life quality allows us to conclude that internal draining of the pseudocysts of the pancreas using endoscopic low trauma method under endosonographic guidance may be an operation of choice for the chronic pancreatitis patients complicated by pseudocysts of the pancreas.

The modern possible options of effective surgical treatment in cases of complicated colorectal cancer with algorithms of step-by-step patient’s management and selection of specific operating tactics in each case are present in the article. These make the possibility to treat patients differently with bleeding, perforations, obstructions.

Relevance: Colorectal cancer (CRC), complicated by acute intestinal obstruction (OKN), takes 3-4 place among the most common in medical practice oncological diseases in the world. CRC, complicated by acute intestinal obstruction, occurs in 5.7-30% of surgical patients. Surgical interventions performed in this group of patients are marked by high rates of mortality and complications - up to 7.6-35%. Objective: to analyze and improve the results of treatment of CRC, complicated by acute intestinal obstruction of tumor origin, through the use of low-impact treatment methods aimed at resolving emergency surgical complications as the final volume of the operation. Material and methods: endoscopic stenting of colorectal cancer, complicated by acute intestinal obstruction, in recent years is the most evolving direction in the concept of real and rapid recovery in this group of patients. In a retrospective study, the results of a clinical observation of 89 patients who, from 2010 to 2016, underwent palliative surgery for malignant lesions of the colon, were evaluated. The main group of patients consisted of 35 patients who underwenta endoscopic stenting of the tumor stricture in an emergency and delayed procedure. 54 patients were formed decompression intestinal stoma. These patients formed a control group. Due to severe concomitant pathology, as well as the presence of an unresectable tumor - the formation of intestinal stomas was performed as the final volume of medical care.Results and discussion: The subject of discussion of this study is the study of the results of endoscopic stenting, applied to patients with colorectal cancer complicated by intestinal obstruction, only for the purpose of symptomatic treatment. The results of the comparison of endoscopic stenting of the colon and decompression intestinal stoma are described. Restoration of the passage through the gastrointestinal tract after endoscopic stenting was noted in all clinical cases. Conclusion: The use of endoscopic stenting by installing self-expanding metal stents for the treatment of colorectal cancer complicated by intestinal obstruction, allows you to quickly restore motor-evacuation function, compensate for metabolic disorders by performing early antegrade digestive tract decompression.

Aim: Develop and implement stage cancer treatment in the standards of surgical care for the malignant colonic obstruction in Moscow Methods: 572 patients diagnosed with malignant colonic obstruction were reviewed: 247 patients of them were hospitalized in 2011-2013 (I group); 325 - in 2014-2017 (II). 46 patients were treated with non-surgical therapy; 302 - underwent acute resection; 141 - stoma construction; 83 - placement of stents. 110 patients (II group) after 0,5-6 months underwent plan resection and radiation or chemotherapy. Acute resection more frequent was performed in I group, plan resection - in II. The comparative analysis of the nearest and long-term results of treatment in two groups is carried out. The 3-year cumulative survival was also plotted on a Kaplan-Meier chart. Stage treatment is implemented in the standards of surgical care for cancer patients in Moscow. The dynamics of postoperative complications in Moscow from 2014 to 2018 is estimated. Results: Complications occurred in 46,69% (I group) and 21% (II). Postoperative mortality was significantly higher in I group compared with II group: 26,11% and 10,33%, respectively. The survival rate was higher in I group than in II group: 0,82 and 0,69, respectively. The result was a decrease in postoperative mortality in Moscow from 22.4% to 10%. Conclusion: The expediency of application of the new surgical standard is confirmed. A bridging strategy may be a valid alternative in some of patients with malignant colonic obstruction, because a significantly lower postoperative mortality rate.