In the present article, the authors carried out with the aim of comparing the analysis of the probability of the occurrence of bile reflux after performing band-separated gastric bypass and standard performance of one anastomosis gastric bypass for morbid obesity.As a result of the study, it was found that when, after the creation of a band-separated pouch and the creation of a hand-sewn gastro-jejunal-anastomosis, the frequency of biliary reflux was significantly less than with the standard version of the one anastomosis gastric bypass.

Objective: To evaluate results of radiofrequency ablation (RFA) in treatment of Barrett’s esophagus.Methods: 80 patients underwent RFA procedure because of Barrett’s esophagus between 2012 and 2019. 40 patients from control group underwent fundoplication only. Preoperative tests included upper gastrointestinal endoscopy, radiography, pH-monitoring and esophageal manometry. Groups were statistically homogenous. We performed follow-up endoscopy 3,6 and 12 months after RFA.Results: Indication for RFA was Barrett’s esophagus with any length and any type of metaplasia. We performed 84 RFA procedures in 80 patients. Total metaplasia eradication was achieved in 97,5% after 1 procedure and in 100% after 2 procedures. Recurrence of metaplasia occured in 2 patients who underwent only RFA without fundoplication.Conclusions: RFA has demonstrated high safety and 100% effectiveness. The optimal scheme is two-step treatment including antireflux surgery and radiofrequency ablation in combination with drug therapy.

Rationale: According to recent studies, purulent complications of postoperative wounds are found quite widely in surgical practice.Objective: to establish the effectiveness of an integrated approach to the treatment of purulent wounds.Methods: the most popular dressings were investigated in the treatment of purulent cavities in patients with suppurative coccygeal cyst.The studied patients in the experimental groups had various comorbidities, such as diabetes mellitus, obliterating atherosclerosis of the lower extremities. Experimental dressings include a dressing agent with antimicrobial properties (with chlorhexidine digluconate), Hydrotül, Activetex HF.Results: In the postoperative period, it is necessary to use broad-spectrum antibacterial drugs. However, in addition to the primary methods it is necessary to apply additional methods of treatment. In particular, we are talking about the use of modern dressings, as well as methods of physical impact on the wound. Among the important additional methods of treatment is physiotherapy, which has a positive effect on the vascularization of soft tissues, thereby enhancing nutrition and epithelialization of the wound. The doctor is faced with the difficult task of determining the most appropriate material for a particular patient among a wide range of dressing materials on the medical market.Conclusion: In patients with an established diagnosis of “abscess pilonidal cyst” who do not have associated diseases, it is most effective to apply a Hydrotül ointment during dressings; in patients with a concomitant diagnosis of atherosclerosis obliterans, the dressing agent with antimicrobial properties (with chlorhexidine digluconate) has the greatest effect; in patients with diabetes mellitus type II - Activetex HF.

The article presents a four-year clinical observation of 89 patients with the clinical picture of sternomediastinitis after median sternotomy. All patients were diagnosed with type 2 diabetes. Patients were divided into 4 groups. It was concluded that the use of a medical complex, which includes vacuum treatment in combination with ozone therapy, allows to speed up the rehabilitation and wound healing in patients with type 2 diabetes.The aim of the research: To improve the effectiveness of treatment of purulent wounds of the sternum after sternotomy through the integrated use of ozone therapy and vacuum therapy in patients with diabetes mellitus.Material and methods: For the period from 2015 to 2019, 1,578 patients with various cardiovascular pathologies were operated on through the sternotomic access in the cardiac surgery department of the Federal Center for Cardio-Sacedial Surgery of Krasnoyarsk. A total of 89 cardiac surgical patients with a clinical picture of sternomediastinitis after median sternotomy were under our observation. All diagnosed with type 2 diabetes. 60% were women and 40% were men. All patients were divided into 4 groups comparable in age, sex and severity of the disease. The results of the study: Analysis of histological and morphometric parameters shows that the rate of change in the cellular composition of the dermis, the degree of development of the vascular bed and granulation tissue, the severity of epithelialization suggests that the most effective is the integrated use of ozone therapy with vacuum therapy in the treatment of purulent steroediastinitis. Conclusion: The use of a medical complex, including ozone therapy and vacuum treatment, allows to speed up the rehabilitation and wound healing in patients with type 2 diabetes. The impact on the wound of vacuum therapy with aspiration of the wound discharge using ozonized distilled water as a therapeutic solution significantly activates the regenerative processes in the wound in patients with type 2 diabetes.

The article describes complex clinical cases that may occur in the practice of an otosurgical surgeon. The difficulty is that there is no clear sequence of actions, how to act in a given situation and how much to go on. To difficult cases in otosurgery, massive labyrinth cholesteatomas with bone defects of cranial pits and the formation of meningoencephalocele, neoplasm of the temporal bone, are indisputable.

In this research we analyzed treatment results of 28 patients with metastatic liver lesions who underwent laser ablation for the period from March, 2017 to March, 2019. Recently the removal of primary sites for R0 and D1, D2 lymphodissection was performed and also received chemotherapy. Laser ablation of metastatic liver lesions (The size of formations was from 10 - 40 mm, average size 29,8 1,7 mm) was performed percutaneously under ultrasound scanning in real time mode. We used the unit of company ECHO LASER for laser ablation, manufactured in Italy. Ultrasound, MRI andCT with intravenous contrast were used for the dynamically control of ablation effectiveness. In early postoperative period were noticed 3-days pain syndrome (could be regulated by the painkillers) and 10-days changing of biochemical analyses (ALT, AST, Alk phos). Either subcapsular hematoma in the area of light guide facility (didn’t required for surgery intervention) was registered. During the morphological study of ablation area (6 months after destruction) was noticed 4 stage pathomorphosis (Lushnikov). Average bed day stood at 4 days. 1-year life expectancy stood at 98%, 2-years stood at 79%.Usage of laser ablation allows to perform surgical intervention with insufficient volume of liver and somatically burdened patients that cannot be performed liver resection.

Enterocutaneous fistulas (ECF) are the most serious postoperative complication of various surgical interventions in abdominal surgery, which pose a threat to the life of the patient. Treatment of patients with ECF is associated with the frequent development of life-threatening complications, such as sepsis and septic shock, intestinal failure, severe water-electrolyte disorders, which causes high mortality rates both according to local authors 35-75%, and according to foreign colleagues 6%-33%. This question is especially relevant in cases of enteroatmospheric fistulas, as well as with high ECF with losses of intestinal contents more than 500 ml per day. In the absence of correct conservative therapy, this quickly leads to the progression of sepsis and the development of multi-organ failure. Surgery performed during this period of time without complex pre-op interview can be fatal and lead to a aggravation of symptoms and death of the patient in the early postoperative period. Each patient requires an individual approach, however, there are general principles of treatment. This review describes the main historical aspects of the formation of medical tactics and the classification of intestinal fistulas.

The best methods of studying the needs of the population in aesthetic plastic surgery are socio-hygienic studies. The aim of this study was to study the attitude of Russian women to seek services in the field of aesthetic plastic surgery. The data were obtained in a survey of 893 women aged 20 to 70 years living in Moscow. The questionnaire includes questions to determine the attitude to aesthetic plastic surgery, counseling and refusal situations, characterize their own behavior when applying for the services of plastic aesthetic surgery. Overall, 43.5% of consultations lead to surgery, the proportion of second and subsequent operations of 79.8%. More often seek consultation and get aesthetic plastic aesthetic surgery women aged 40-49 years and 50-59 years. The share of operated after consultation in the age group 20-29 years is significantly higher (p=0.02) than in the group 60-70 years and is statistically equal to the group 50-59 years (p=0.07). The results of the survey indicate an increase in the need for plastic aesthetic surgery; reducing the age of the average consumer of plastic aesthetic surgery services; lack of activity of psychologists in the treatment of patients for aesthetic plastic surgery.

The publication highlights the features of simultaneous operations, provides historical background, definition and statistics. It is established that most often the main operation is cholecystectomy, performed in a low-traumatic way: laparoscopically or from mini-access. The substantiation of such surgical interventions on several organs and the principles of their implementation in different clinics is given. It is established that the range of these operations is quite wide and continues to expand, despite the negative attitude of insurance companies to them.

The problem of morbid obesity is an urgent issue in the modern healthcare system. Morbid obesity has a negative effect on the reproductive function of women. One of the striking examples of which is infertility. Studies have found that bariatric surgery has a positive effect on the reproductive function of women with morbid obesity. The effect of various surgical methods on fertility in patients undergoing bariatric surgery is still controversial. A multicenter study showed that there is no difference between restrictive and malabsorption bariatric surgery methods. Obesity has been shown to have serious potential consequences for female fertility factor. In the fight against obesity, one should regulate eating habits and increase physical activity. Bariatric surgery should be used only in cases where all other complex measures have not yielded any results. The review is devoted to the scientific analysis of the effects of morbid obesity and bariatric surgery on female fertility.Conflict of interest: the Authors declare no potential conflict of interest.Materials and methods: Full-text articles and / or abstract's published between 01.01.2000 and 01.10.2018, found through the national scientific library PubMed, were analyzed.