Background. Although Biliopancreatic Diversion (BPD) currently is infrequently used in metabolic surgery, SADI-S (Single Anastomosis DuodenoIleal + Sleeve) technique may revive interest to hypoabsorptive surgery not only as a second-step but also as a primary metabolic procedure. There are only small comparative studies between SADI-S and Hess-Marceau's BPD/Duodenal Switch (BPD/DS) operations.Objectives. To evaluate retrospectively 5-year experience of SADI-S with common limb of 250 cm (SADI-S 250) and to compare results with standard Hess-Marceau's BPD/DS.Methods. 226 patients underwent SADI-S 250 with Sleeve Gastrectomy (SG) between May 2014 and August 2019. Diabetes mellitus type 2 (DM2) was diagnosed in 80 (35,4 %). Patients who underwent second-step SADI-S after previous SG were not included. General follow-up rate after SADI-S was 98,2%. Percent of Excess weight loss (EWL), antidiabetic effect, complications and revision rate were compared with results of BPD/DS in series of 528 patients operated within years 2003-2015 (general follow-up rate - 99,2%).Results. % EWL during the fi st year and to nadir at 18 months was some better after SADI-S than after BPD/DS (81,0 % vs.77,6 %, p<0,01). To the fourth and fifth years better EWL was observed after BPD/DS than after SADI-S (75,0 % vs. 68,0 %, p<0.001 and 74,6 % vs. 65,8%

Non-alcoholic fatty liver disease (NAFLD) is characterized by a chronic course and steady progression with the development of severe life-threatening complications. The prevalence of this pathology is increasing, and in most cases NAFLD is associated with obesity.A large number of methods for treating NAFLD have been developed, however the role of bariatric surgery isn’t fully understood. At the same time, bariatric surgery is widely recognized as the most effective way of treating obesity and its comorbid pathologies. The authors aim to review the literature data on the assessment of the impact of bariatric surgery on the course of NAFLD in obesity.

Background: Peptic ulcer perforation accounts for 10-15% of all complications of peptic ulcer and is one of the main causes of high mortality.Study Purpose: Optimization of the choice of surgical intervention and improvement of the surgical outcomes in patients with perforated peptic ulcers based on the Boey prognostic score and national clinical guidelines.Study material and methods: We performed the analysis involving data of 263 patients who undergone surgery in the Botkin Memorial Hospital from 2012 to 2018 in which the perforated peptic ulcer was sutured. There were 181 men (68.8%), 82 (31.2%) women. Patients were aged 19 to 87 years. Mean age was 52.4±11.6 years. Perforated gastric ulcer occurred in 74 (28.2%) patients, and ulcer on the duodenal bulb in 189 (71.8%) patients. Group 1 included patientswho were treated over the period from 2012 to 2014 (n = 127). In this group, laparoscopic intervention was performed in 76 (59.8%) patients. Laparotomy with subsequent suturing of the perforation hole was performed in 51 (40.2%) patients. Group 2 included patients who were treated from 2015 to 2018 (n = 145), in which the surgical method was determined based on the Boey score and national clinical guidelines. In this group, laparoscopic suturing of the perforated ulcer was performed in 90 (62.1%) patients. In 55 (36.6%) patients, surgery was performed from laparotomy access. The study groups were compared in terms of the time of the surgical intervention, the frequency of conversions and postoperative complications, hospital stay, mortality rates.Outcomes: In Group 1, a perforated ulcer suturing with complete lavage of the abdominal cavity using the laparoscopic method was feasible to be performed in 76 (59.8%) of 84 patients. Conversion occurred in 8 (9.5%) patients. Surgery duration was 117.5±19.8 minutes. Complications were observed in 12 (15.8%) patients. Postoperative inpatient days were 5.6±1.4. After the laparotomy suturing of the perforated ulcer, complications were present in 14 (22.6%) patients. Surgery duration was 96.7±12.3 minutes and postoperative inpatient days were 9.6±2.3 days. The overall mortality rates in this group were 4.8%. In Group 2, laparoscopic intervention was feasible to be performed in 90 (62.1%) of 92 patients. Conversion occurred in 2 (2.2%) patients. The duration of the laparoscopic intervention was 86.7±14.3 minutes and the laparotomy intervention was 83.7±11.8 minutes. Complications were observed in 5 (5.4%) and 12 (22.6%) patients, respectively. Postoperative inpatient days with laparoscopic method were 4.1±1.7 days and with laparotomy 8.7±2.5 days. The overall mortality rates in this group were 2.8%.Conclusion: Laparoscopic suture of perforated peptic ulcer is a minimally invasive and effective method of treatment, this leads to a decrease in the number of conversions, postoperative complications, hospitalization time, reduced mortality and improved results of surgical treatment. The use of the Boey prognostic scale, taking into account national clinical guidelines, allows reasonable application of the optimal method of surgical treatment, surgical intervention in62.1 % of patients by laparoscopic method and reduce the number of conversions to 2.2%.

The purpose of this work was to evaluate the prospects of using titanium thread mesh implants in the treatment of postoperative ventral hernias. Material and methods: in this paper, a comparative analysis of the immediate and long-term results of treatment of 62 patients with postoperative ventral hernias, operated on as planned. The main group included 28 patients who had mesh implants made of titanium thread installed during hernioplasty, and the comparison group included 34 patients who were operated using a polypropylene mesh implant. Quality of life was assessed in 12 (43%) patients of the main group and 10 (29%) patients of the comparison group.Results: more than 75% of patients in both groups underwent hernioplasty with implant fixation under the rectus abdominis (sublay retromuscular hernioplasty). All patients were operated from traditional access. The article presents the immediate results of surgical treatment of patients with postoperative ventral hernias. A comparative analysis of the quality of life of patients 1 year after surgery was performed.Conclusion: the analysis of the results showed that the use of mesh implants made of titanium thread does not contribute to an increase in the frequency of postoperative complications, and the degree of inflammatory response to the implant in the early postoperative period is less pronounced. 1 year after surgery the quality of life of patients did not depend on the type of implant used. The use of titanium thread mesh implants in hernioplasty was accompanied by a statistically significant increase in the role of physical and emotional functioning of patients.

Aorto-iliac surgical reconstructions are currently the gold standard in abdominal aortic aneurysm surgery. Endovascular abdominal aortic prosthesis is currently being considered as a potential alternative to standard intra-abdominal surgery. However, with the accumulation of experience in endovascular prosthetics, a large number of restrictions for this method of treatment have been revealed. However, in recent times, the rise of surgery on the aorto-iliac segment with the use of mini-laparotomy incisions, which are implemented by the classical techniques of reconstructive surgery of the abdominal aorta, essentially as a modifi ation of the standard open surgery, but at the same time, having a number of advantages over traditional and endovascular prosthetics abdominal aorta and potentially shows a greater number of patients with abdominal aortic aneurysms.The aim of the study is to compare the immediate results of surgical treatment of abdominal aortic aneurysms with endovascular and open mini-laparotomy methods.Material and methods: The article analyzes the immediate results of surgical treatment of 57 patients with abdominal aortic aneurysms. The differences were in the tactics of surgical treatment: 40 patients underwent abdominal aortic prosthetics from mini-laparotomy access, 17 patients received abdominal aortic endoprosthesis.Results: A comparative analysis of the immediate results of surgical and endovascular treatment of patients with abdominal aortic aneurysms shows comparable data for most indicators of the intraoperative period, postoperative rehabilitation of patients, and the frequency and severity of perioperative complications. Both methods have obvious advantages over traditional abdominal aortic prosthetics from a full laparotomy. Conclusion. Mini-laparotomic access during operations for abdominal aortic aneurysms can be a good alternative to both traditional prosthetics and endoprosthetics of the abdominal aorta, combining all the advantages of both open surgical and endovascular intervention.

Due to the need of more sensitive methods for the morphological detection of precancerous changes in the gastric mucosa (coolant) with atrophic gastritis, the research goal was to study the prevalence of precancerous changes in the coolant in atrophic gastritis as part of a new morphological modifi ation of the Kimura-Takemoto classifi ation. We examined 169 patients selected by Kimura-Takemoto endoscopic criteria. There were 58 men (34%) and 111 women (66%). The average age was 66.44 ± 10.22 years. The biopsy was taken according to the protoсol from each site indicated by the boundaries of the atrophy C1, C2, C3, O1, O2, O3. The histology results were interpreted according to the visual-analogue scale of the Sydney system. Among 169 people, six patients had high-grade dysplasia. These patients did not show a strong correlation with severe intestinal metaplasia (r = 0.53, p> 0.05). In two patients with severe dysplasia out of six, intestinal metaplasia was not detected at all. Severe dysplasia was found in three patients (51, 70 and 76 years) with verifi d gastric cancer. These patients were fi st approached and were clinically diagnosed with late cancer. Th ee more patients with verifi d diffuse coolant atrophy died in the near future from cardiovascular diseases. Their age, at the time of detection of atrophic gastritis with severe dysplasia was: 69, 87 and 79 years. The effectiveness of research methodology for the morphological diagnosis of precancerous changes in coolant biopsy specimens in atrophic gastritis in accordance with the Kimura-Takemoto endoscopic classifi ation was proven.

Intestinal obstruction (ileus) is one of the most formidable pathological conditions encountered both in abdominal surgery and in other areas of medicine in a number of diseases. The introduction of the technique of robot-assisted radical prostatectomy (RARP) can signifi antly reduce the risk of complications, but not completely exclude it. Given the occurrence of this complication and its direct effect on the patient’s condition, attention should be paid to preventive and therapeutic measures that contribute to the reduction and faster resolution of postoperative paresis. For this, it is necessary to take into account pathogenetic factors that contribute to the appearance of ileus and, taking them into account, build a treatment plan and preventive measures.

The article shows the Willis circle effect on the ischemic stroke outcome after successful endovascular thrombectomy with anterior circulation isolated cerebral artery occlusion and combined with extracerebral artery occlusion.Objective: To identify the stroke outcomes difference after successful thrombus removal from the anterior circulation artery, depending on the acute combined nature occlusion and the anatomical and physiological characteristics of the arterial brain circle.Methods: A thrombectomy group with combined middle cerebral and internal carotid arteries combined occlusion is represented by 26 patients. Another 26 patients underwent thrombectomy with isolated middle cerebral artery occlusion. The Willis circle anatomical features and the concomitant brachiocephalic arteries atherosclerotic lesion were retrospectively analyzed. A statistical evaluation of inpatient treatment results and complications of these groups was carried out using nonparametric methods.Results: The overall disability level was higher in the 1st group. A Carotid artery reocclusion in the 1st group was detected in 30.77% (8), which amounted to 61% of all tandem occlusions. But there was no signifi ant internal carotid artery reocclusion effect on the death relative risk this group. It was shown that the Willis circle fl w state did not show statistical effects on mortality, disability, and hemorrhagic complications both groups.Conclusions: The patient's survival with anterior arterial circulation acute stroke depends on the cerebral arteries supply restoration. Combined occlusions anterior cerebral circulation increase disability prognosis. The Willis circle fl w state did not demonstrate a statistical prognosis effect on the patients after successful thrombectomy.

Reason of the study. Facet syndrome is one of the most common causes of back pain. A detailed clinical analysis of the pain syndrome of this disease has not been conducted yet.Purpose of the study. To analyze the clinical signs among patients with lumbar facet syndrome based on the effectiveness of facet joint block.Material and methods. The various pain patterns in 56 patients with lumbar pain were analyzed. Pain was assessed by using a visual analogue scale (VAS). We analyzed patterns of the irradiation of pain and the dynamics of pain at different patient’s positions. All patients underwent facet joint block at the level of pain. According to the regression of pain patients were divided into groups. The pain in paients of group I was decreased more than 50%, in group II - to 25-50%, in patients of group III - less than 25%. Patients of different groups were compared with each other.Results. Among patients of group I (true facet syndrome), the following symptoms were more common: increasing pain when leaning forward and backward, irradiation of pain along the lateral surface of the thigh. Signs that were less common among patients of group I compared with patients of other groups were following: increasing pain in a sitting position, irradiation of pain along the back of the thigh and groin.Conclusion The following clinical signs are more typical for a true lumbar facet syndrome: a decreasing pain in a sitting position, irradiation of pain along the lateral surface of the thigh to the knee, increasing pain when leaning forward and backward.

Goal: hatal hernia (HH) remains a topical surgical issue as it is always accompanied by gastroesophagal reflux causing patients complains of heartburn. Reflux and consequently reflux-esophagitis results in severe esophageal complications (Barret's esophagus, esophageal cancer), extraesophagal problems such as bronchial asthma and laryngitis. However, at present the main issue in managing rexlux patients is the reduction in their life quality. Herein assessment of life quality may be a valid marker of surgical treatment effi cy. Methods: here we estimate a Nissen-Rosseti modifi d technique in comparison with the original operation. Life quality was assessed in both groups of patients in early and remote periods after surgery. Totally 86 patients were enrolled (42 underwent original Nissen-Rosetti operation, 44 were operated on using the modifi d technique). In order to estimate life quality we utilized GSRS and SF-36 scales. Results: аnalysis demonstrates moderate superiority of modifi d hernioplastics according to both scales in early and remote period. Better results in this group rely on technical novelty (including patent-pending features) of the modifi d operation as compared to the original method. Conclusion: higher life quality in the abovementioned group, modifi d laparoscopic technique for Nissen-Rosetti operation can be recommended for clinical practice in GERD-oriented surgical centers.

The analysis of the current state of purulent-inflammatory diseases of the fi gers and toes. The main causes of this pathology are considered. It is shown that there are several classifi ations of purulent diseases of the fi gers and toes. The basis of all classifi ations is the clinical and anatomical principle, that is, the anatomical localization of the main purulent-inflammatory process and its external manifestations. The characteristic of the main clinical signs of purulent-inflammatory diseases of the fi gers and toes is given, as well as modern prophylaxis and treatment methods are analyzed. So, the subungual panaritium and paronychia usually develop during contamination with the most common pathogens of purulent infection, sometimes in association with mycotic fl ra. The addition of additional etiopathogenetic factors against the background of comorbid conditions contributes to the formation of deformations, incarnations (ingrowths) and polyetiological lesions. Mycotic-associated pathology with the destruction of nails and subungual structures, which may be complicated by osteomyelitis, requires the use of surgical resections or onyctomy. In the presence of destructive onychomycosis, in parallel with the use of combined antimycotic therapy, in most cases, the removal of the changed nail and the rehabilitation of pathological layering of the nail bed are indicated.

Currently, an extremely important problem of medicine is the search for timely surgical interventions and assessment of its consequences. It is known that inflammation proceeds with a change in metabolic and biochemical processes that occur next to the symptoms, and not in terms of determining the severity, time of occurrence of diseases, the occurrence of chronic pathological conditions caused by inflammation caused by surgical intervention. In this case, the defi tion of markers of inflammation is used. The concentration of these proteins leads to damage that is extremely important for diagnosis. The most informative proteins for analysis are C-reactive protein and ceruloplasmin, as well as complex diagnostics using various acute phase proteins simultaneously. It is also possible to use tests for the presence of anti-inflammatory interleukins, procalcitonin, neopterin, autoantibodies (IgG) in blood plasma to determine inflammatory processes. In addition, data from a blood test and determination of the number of leukocytes using calculations by theleukocyte index of inflammation are used.

Based on the data analysis performed on 401 patients treated at the municipal budgetary institutions Health «City Emergency Hospital», of Rostov-on-Don city, from 2014 to 2018. The validity of the possible predictors of recurrence of gastrointestinal bleeding was determined. Inclusion criteria were: Diagnosis of ICD 10: K 25.0. K 25.4, K 26.0, K 26.4, informed consent of the patient. Exclusion criterion: gastrointestinal bleeding due to portal hypertension, Mallory-Weiss syndrome, and symptomatic ulcers. The patients were divided into groups: Group 1: No bleeding recurrence 87,53 % (351). Group 2: Recurrent bleeding 12,47 % (50). What are established as predictors of recurrence of gastrointestinal bleeding are: severe bleeding, and bleeding Forrest 1a. To these patients with ineffective endoscopy, emergency surgical treatment is indicated. Predictors of moderate prognostic signifi ance of recurrent bleeding include comorbidity, anamnesis, Rockall score ≥ 8 points, systolic blood pressure ≤ 100 мм рт. ст., heart rate ≥ 100 bpm, total protein ≤ 55 g/l, urea ≥ 10,0 mmol/l, PTT ≥ 45 sec, HGB ≤ 100 g/l, thrombocytes ≥ 350 х 109/l. When predictors of moderate severity of recurrent bleeding are identifi d, transluminal endoscopic surgery is required. Predictors of low signifi ance of recurrent bleeding are age ≥60 year, bleeding Forrest 1b и 2b, Glasgow-Blatchford bleeding score ≥ 13 points, creatinine ≥ 240 mkmol/l, patients in need of prolonged observation in a hospital. In patients without recurrence of bleeding, endoscopy is the ultimate hemostasis in 97,15 %. With recurrence of bleeding, endoscopy is effective in 36.0%. Predictors of recurrence of bleeding are: severe bleeding, objective indications for blood transfusion, repeated blood transfusion, age>70 year, comorbidity, long term use of anticoagulants, history of ulcer, total protein in plasma < 55 g/l, PTT > 45 sec, thrombocytes ≥ 350 х 109/l, as well as disseminated intravascular coagulation.

Hiatal Hernias are common diseases in surgical and gastroenterological practice and are detected in almost 30% of the adult population of Russian Federation. Purpose of the study: improving the treatment results for patients with complicated forms of hiatal hernia by developing an individual integrated approach taking into account the body type, anatomical and agerelated features. Materials and methods. In this work, age and constitutional features of the biomechanical properties of fascial structures, as well as blood supply to the diaphragm, are studied on 40 preparations from human corpses. The clinical part of the work includes the experience of treating 163 patients with complicated forms of hiatal hernias. Results. Based on the data of anatomical studies, plastic surgery of the esophageal opening of the diaphragm was performed, using own tissues (n = 124) and using mesh implants (n = 39). Late postoperative complications were studied up to 5 years in 117 of 124 patients (94.4%) with using their own tissues and in all 39 patients with using mesh implants. After surgery with using own tissues, 11 (9.4%) late complications were revealed: fundoplication cuff migration noted in 3 patients, telescope phenomenon - 2 cases, cuff hyperfunction - in 1 and gastroesophageal reflux - in 5 patients. In the group of patients with mesh implants, only one patient (2.6%) showed gastroesophageal reflux, the effect was achieved by using conservative treatment methods. There were no relapses of the disease both with using own tissues and with the use of mesh implants. Conclusion. In the second mature period and in old age, especially in individuals of a brachymorphic body type with large hernias of the esophageal opening of the diaphragm, mesh implants should be used to strengthen the diaphragmatic legs. The developed original method of surgery using a mesh implant allows to reduce the risk of damage to adjacent organs and structures.

The aim of the research: To determine the main modern aspects in the diagnosis and management of pregnant patients who have suffered certain types of injuries, taking into account the anamnestic, anatomical, physiological, hormonal, psychological and many other features of the pregnant body and formulate the rules and algorithms of curation, according to modern recommendations.Materials and methods: An analysis was made of various domestic and foreign medical literature sources that have information and data from their own and third-party studies on the modern aspects of the diagnosis and management of pregnant patients who have suffered various injuries, including articles, monographs, journals and textbooks for students of higher educational institutions and residents.The results of the study: It was revealed that each item in the algorithm of management and diagnosis of pregnant patients who have suffered various injuries requires an exceptional approach due to the characteristics of the pregnant body. The nuances of the survey, physical examination, the choice of various methods of instrumental and laboratory research and the method of delivery depend not only on the severity and type of injury received, but also on the obstetric and gynecological history of each individual patient, which may indirectly indicate future immediate and long-term complications and influence the chosen tactics of supervision.Conclusion: The analysis shows that each case of injuries in pregnant women is unique not only because of the type, severity and complications of a particular injury, but also because of the fact of having a pregnancy. The pregnant body reacts in a special way to all exogenous influences, which indicates the need for accurate knowledge on the diagnosis of injuries and management of pregnant patients, according to modern recommendations.

Purulent mediastinitis can develop in patients of any age and are characterized by a severe, progressive course with a high mortality rate. The causes of mediastinitis can be: complications of inflammatory diseases of the lungs, pleura, trachea, neck, oral cavity, larynx, pharynx, esophagus, heart. Primary mediastinitis occurs as a result of trauma and exogenous infection with open gunshot injuries of the mediastinum, with instrumental manipulations (esophageal esophageal surgery, esophagoscopy, tracheal intubation, tracheostomy, gastric probing, cardio-dilatation, and often injuries occur from foreign bodies of the esophagus, trachea, burns, tumors, perfora, perfora spontaneous rupture Primary mediastinitis can develop after operations on the organs of the chest, with anasto failure brains of the esophagus, trachea, bronchi, after cardiosurgical operations and infection of the mediastinal fiber.The primary source of infection can be phlegmon of the upper and lower extremities, frostbite, osteomyelitis of the lower jaw, pharyngeal abscess, phlegmonous mumps, purulent lymphadenitis, sepsis. Microfl ra in mediastin is presented mixed infection. Anaerobes (bacterioids, peptostreptococci, fusobacteria, Prevotella, etc.) can be combined with aerobes (staphylococci, streptococci, Klebsiella), their synergism is determined malignant course of mediastinitis and high mortality.

Sepsis and septic shock are the main causes of system dysfunction in many organs and death in the intensive care unit. The pathogenesis of sepsis is complex and consists of a network of interconnected pathways. For these reasons, an immunomodulatory strategy should restore immunological stability, and not inhibit or stimulate one or another component of this complex network. Therefore, the focus of immunomodulatory therapy in sepsis should be directed to non-specifi methods of influencing the entire inflammatory response without suppressing it. Over the past few decades huge changes have occurred in the approach to the choice of methods of molecular transfusiology in critically ill patients.Th s study provides an analytical review of current literature on the issue of extracorporeal detoxifi ation in intensive care for severe sepsis. It has been shown that extracorporeal detoxifi ation in sepsis, from the perspective of evidence-based medicine, is an effective direction in the treatment of severe sepsis.

It is proposed to discuss the idea of surgical correction of chronic colonic stasis by applying a controlled (functional, creative) cecostomy or resection of a section of the jejunum.