Amongst the variety of patient complaints the severe forms of panaritium are the most common at Moscow clinics specialized in purulent surgery. Abundance of developing such pathology is caused by number of reasons, one of which is that patients visiting a doctor very late. Typical outcome of late start of a treatment is an amputation of phalanx of the fingers, sometimes whole fingers, what could lead to obtaining a disability status even in comparatively young patients, particularly with I-fingers affected. We have conducted a 4 State clinical hospital in Moscow based study of treatment two groups of patients. First group underwent classical surgery, i.e. necrotomy, and treatment, including draining. Another group underwent intraoperative necrotomy performed by specific laser device “Atcus-2” (St.Peterburg, Russian Federacion). In given study laser radiation settings have been estimated for the first time, as well as necrotomy and necrsequestertomy techniques. Comparative results after treatment in two groups of patients show significant improvements in course of wound process, rapid debridement in patients which received laser treatment. Attenuated necrsequestertomy in bone forms of panaritium is possible in this group, which is essential, considering a finger functional importance in workflow. With all abovementioned, we can say that laser necrotomy is an actual and effective technique in complex treatment of severe forms of a forms of panaritium.

The authors in the review article analyze the main disadvantages and complications in bariatric surgery. Data from leading international publications on the topic are presented and the causes of various adverse outcomes of bariatric operations are discussed.

Aim. Improving the results of treatment of patients with severe acute pancreatitis with multiple organ failure and acute renal failure.Materials and methods. The cases of 140 patients who had a history of severe acute pancreatitis with symptoms of multiorgan or isolated renal insufficiency over the period 2014-2018 were analyzed. Two groups were formed: the 1st (n-80, 2016-2018) and the 2nd (n-60, 2014-2015). Of the total number of all patients, there were 85 (60.7%) man and 55 (39.3%) women, with a ratio of almost 1.5:1. The average age of the patients included in the study was 48.22 ±12.32 years in the 1st group, 47.58 ± 10.56 years in the 2nd group (p≥0.05). In the 1st group all patients with severe acute pancreatitis used to determine the severity of acute kidney damage on the RIFLE scale with the onset of efferent therapy according to the degree of organ damage: R, I, or F. The 2nd group was treated without taking the RIFLE scale (only the retrospective scaling). At the time of admission to the hospital, there was a commensurability of research groups in terms of laboratory parameters, duration of illness, and comorbid background. In group 1, the bulk were patients with severity of acute renal damage in the risk (R-R) stage, which accounted for 49 patients (61.25%). The injury stage was noted in 10 patients (12.5%), the rest were stratified into groups R-F (“disturbance”; 18 patients, 26.25%). Analysis of the clinical material of group 2 also made it possible to distribute patients according to the severity of renal damage, which was carried out on the basis of a retrospective analysis: stage “R” was noted in 41 (68.3%), “I” in 6 (10%) and “F” in 13 (21.7%) patients. Low and medium volume hemofiltration were referred to as “renal” (R-R and R-I), and high-volume methods for the treatment of the “R-F” stage.Results. According to the type of acute renal failure, all patients of group 1 were subjected to renal replacement therapy by the method of prolonged low-flow veno-venous hemodiafiltration: start of therapy at 3.0 ± 0.8 days from the moment of hospitalization. In patients of group 2, similar technologies were used only in 35 patients (58.3%), while in the remaining patients, renal replacement therapy was not performed at all. The timeline for the implementation of low-flow veno-venous hemodiafiltration in group 2 was 6.1 ± 1.0 days from the time of hospitalization (p≤0.001), mainly due to extrarenal indications. A total of 294 procedures of prolonged low-flow veno-venous hemodiafiltration were performed in the presented clinical material with distribution from 1 to 6 sessions per patient, which averaged 1.82 ± 0.87 sessions per person. The duration of sessions of efferent therapy ranged from 12 to 79 hours, which was on average 31.9 hours per patient per session. The dynamics of the compared laboratory and calculated data was identical in the studied groups, however, there was a clear tendency to more slowly decrease biochemical and manometric parameters when using lower values of convection velocity (group 2; according to retrospective analysis). In the main group of patients, there were 5 deaths (6.25%) versus 18 (30%; p≤0.05) in group 2.Conclusion. Based on our studies, we convincingly demonstrated the validity of including extended renal replacement therapy in a complex of therapeutic measures in patients with severe acute pancreatitis, as well as a dose-dependent effect on the rate of ultrafiltration and convection. Such an algorithm will significantly increase the survival rate in severe acute pancreatitis with symptoms of acute renal damage.

The article presents a clinical and economic analysis of the results of the use of stapleless and standard one anastomosis bariatric gastric bypass using of endoscopic staplers.As a result of the analysis by the method of “cost minimization”, it was established that with the same clinical efficacy of the two compared methods, the stapleless method is much cheaper and, accordingly, more economically advantageous for practical use.

Surgical treatment of patients with POVH and domain loss is today the cornerstone for herniologists of the world. The literature data concerning the surgical treatment of patients with giant postoperative ventral hernias with «loss of domain» has been analyzed. And the described methods of preoperative preparation (preoperative progressive pneumoperitoneum, injections of botulinum toxin type A and their combination) show good results in the treatment of patients with POVH, with a hernia defect width of more than 10 cm and accompanied by a loss of domain, which in some cases avoids separation plastics.

The problem of treating patients suffering from severe cardiovascular diseases and tumors of various locations remains unsolved in oncology. Even specialists from multidisciplinary centers encounter difficulties, the main of which are: deciding on simultaneous or staged treatment, determining the staging of interventions, the timing of their implementation, preoperative preparation and treatment in the postoperative period. For the most part, the category of patients of senile age is presented, with a considerable set of concomitant chronic and acute diseases of varying degrees of compensation. A significant number of cancer patients suffering from severe cardiovascular disease are treated in our multidisciplinary center. In this connection, we would like to share some experience in this area. Two clinical cases are presented in the article: treatment of a patient with a stenotic tumor of the sigmoid colon against the background of acute infectious endocarditis and the next treatment of a patient with malignant colon, aortic valve disease and stenosing lesion of the brachiocephalic arteries. In the first clinical case, the patient revealed infectious endocarditis, then a tumor of the sigmoid colon. The patient underwent a course of systemic antibacterial therapy, after which he underwent resection of the sigmoid colon. After eighteen days, the cardiac surgery stage was performed prosthetics of the aortic and mitral valves. The second clinical case describes the treatment of a patient who has identified indications for surgical correction of severe aortic stenosis. During treatment, atherosclerosis of the brachiocephalic arteries and a tumor of the ascending colon were revealed. By the decision of the interdisciplinary consultation of the patient, stenting of the carotid artery was performed, then transcatheter implantation of the aortic valve followed by right-sided hemicolectomy. Both cases were an example of successfully chosen tactics, as evidenced by the data of long-term postoperative oncological and cardiological follow-up.

The aim of this study was to clarify the efficacy of the ERAS protocol for gastric cancer surgery.We provided a systematic review of randomized controlled trials and retrospective cohort studies involving either enhanced recovery after surgery (ERAS) or fast track surgery (FTS) for patients after gastrectomy for cancer. EMBASE, Pubmed, Cochrane were searched. Primary outcomes were early postoperative morbidity, mortality and length of hospital stay. Inclusion criteria were: studies published from 2010 to 2019, in English, at least 60 patients enrolled, with a detailed protocol of enhanced recovery. Secondary outcomes: early postoperative results (pain scale, mobilization, first defecation, soft food taken) and cost. 10 trials were eligible for review. Compared with conventional care group, ERAS led to decreased incidence of overall complications and didn't influence the leakage rate. ERAS implementation resulted in rapid postoperative recovery of gastric cancer patients after gastrectomy. It was associated with less pain, early defecation, early start of soft food intake. The readmission rate was comparable to conventional care group. Also, ERAS showed economical benefits because of decreasing the length of hospital stay, decreased cost of treatment and same readmission rate. Conclusion: Our systematic literature review showed that ERAS programs are safe and feasible for gastric cancer patient after gastrectomy. Future prospective randomized clinical trials are necessary to detect the role of ERAS programs in European gastric cancer patients, elderly and «high risk» patients.

Elaparoscopic fundoplication has gained rapid surgery and is the gold standard in the treatment of hiatal hernia and gastroesophageal reflux disease. However, with the invention of robot-assisted laparoscopic technologies, disputes over this or that minimally invasive technology have not subsided. Methods. A group of authors from 2015 to 2019 y.e. 363 surgical treatments was performed for the treatment of hiatal hernia and gastroesophageal reflux disease. Patients were stratified on laparoscopic fundoplication or robot-assisted laparoscopic fundoplication. Intraoperative and postoperative results were evaluated. Results. All 363 patients completed Nissen fundoplication: laparoscopic fundoplication - 291 (80.17%) patients, robot-assisted laparoscopic fundoplication - 72 (19.83%) patients. Intraoperative and postoperative results are comparable with each other. Complications of Clavien-Dindo Classification >3 were observed in 3 patients in the laparoscopic fundoplication group. The follow-up period for patients of the laparoscopic fundoplication group ranged from 1 to 53 months (median - 19 months), for patients of the robot-assisted laparoscopic fundoplication group ranged from 1 to 41 months (median - 13 months). Conclusion. The observed values demonstrate that robot-assisted laparoscopic fundoplication is comparable to laparoscopic fundoplication in terms of a workable result.

The aim of the study was a comparative analysis of the longterm results of the functioning of covered selfexpandable metal stents (CSEMS) with a diameter of 8 and 10 mm with distal malignant biliary obstruction (DMBO). In the Botkin hospital (Moscow) for the period from 2010 to 2018 according to the criteria, the study included 74 patients with endoscopic stenting CSEMS with DMBO. Patients were divided into 2 groups: 1 - 33 CSEMS with a diameter of 8 mm, 2 - CSEMS with a diameter of 10 mm. The groups were statistically homogeneous. Clinical success was achieved in 94.3% of patients in group 1 and 95.8% of patients in group 2 (p = 0.096). Acute cholecystitis: 1 to 3 (9.6%); 2-5 (11.6%) (p = 0.139); acute pancreatitis:1 - 5 (16.1%); 2 - 9 (20.9%) (p = 0.067). Average time to repeated biliary obstruction: 1 - 244 days; 2 - 269 days (p = 0.119). The median (range) of theobservation period was: 1 - 174 (34-385) days; 2 - 193 (19-406) days (p = 0.836). Median survival: 1 - 156 days; 2 - 138 days (p = 0.716). The frequency of cases without repeated biliary obstruction at the time of death was: 1 - 58.1% (18/31); 2 - 65.1% (28/43) (p = 0.046). Thus, we can conclude that it is not possible to use CSEMS with a diameter of 8 or 10 mm with DMBO without significant influence on longterm results.

The scientific and practical activity of academician A.V. Vishnevsky is analyzed. Little-known facts from the life of the scientist are highlighted. It is noted that A.V. Vishnevsky was the author of more than 100 scientific papers on clinical surgery, anesthesiology, urology and neurosurgery. The "Kazan" period of the scientist's creative activity is covered. It is shown that a major scientific achievement of A.V. Vishnevsky and his scientific school is the development of local anesthesia by the method of "creeping infiltration", as well as issues of nervous trophy, treatment of wounds and inflammatory processes. It is emphasized that the scientist put forward and theoretically substantiated the original scientific concept of the importance of weak stimulation of nerve receptors for the normalization of trophic and reparative processes and proposed for this purpose extensive oil-balsamic dressings, local anesthesia and novocaine blockade-lumbar, vagosimpatic, sheath, presacral, short novocaine block, etc. These methods were widely used for the treatment of the wounded during the great Patriotic war. The author analyzes the fact that in combination with other nonspecific pathogenetic agents, these techniques were used to treat traumatic shock, obliterating endarteritis, trophic ulcers, burns, frostbite, inflammatory processes, etc.it is Emphasized thatA.V. Vishnevsky was the Chairman of the Surgical society of the Tatar ASSR, the Moscow surgical society, a member of the Board of the all-Union society of surgeons. In memory of him, a bronze medal is embossed, and a bust of academician Alexander Vishnevsky is installed on the Territory of the Instituteof surgery of the USSR Academy of medical Sciences in Moscow.