Abstract: the purpose of this work was to study the long-term results of treatment of anterior abdominal wall hernias with the use of mesh implants made of titanium thread.

Material and methods: In this study, a comparative assessment of the long-term results of treatment of 118 patients with umbilical and inguinal hernias was performed. In 62 patients of the main group, a mesh implant made of titanium thread was used, and 56 patients of the comparison group were operated with a polypropylene mesh implant. In the main group, 14.5% of patients were operated from laparoscopic access,  and 9% in the comparison group. The quality of life assessment was performed in 37 (60%) patients from the main group and in 31 (55%) patients from the comparison group.

Results: the Median duration of temporary disability after discharge was 7 days and did not differ significantly  in both groups. 3 months after the operation, the average area of titanium thread implants decreased by 1.8-2.3%, depending on the type of operation. There were no differences in the quality of life between patients of both groups within the period from 6 months to 2 years from the moment of surgery. 2 years after inguinal hernioplasty, no more than 4.8% of patients experienced discomfort at the site of surgery.

Conclusion: the analysis of long-term results of treatment of anterior abdominal wall hernias using a mesh implant made of titanium thread showed no significant differences in the terms of temporary disability after discharge, the level of quality of life and the frequency of implant-associated complications in comparison with the use of a polypropylene implant. The degree of shrinkage of titanium thread mesh implants within 3 months  after surgery is minimal.

Abstract: Aims. To develop methods for predicting the rebleeding of peptic ulcer, to develop an algorithm for choosing therapeutic tactics based on predicting rebleeding.

Methods. 2 retrospective case-control studies were conducted. The first study included 240 patients with peptic ulcer bleeding, which were divided into 2 groups: group 1 - 52 patients with rebleeding; group 2 - 188 patients without rebleeding. The second study included 108 patients with peptic ulcer bleeding who underwent endoscopic hemostasis. Patients are divided into 3 groups depending on the location of the ulcer and the  difficulty of performing endoscopic hemostasis

Results. According to the results of the first study, it was possible to identify the following clinical, laboratory and endoscopic criteria associated with the onset of rebleeding - shock index, localization of ulcers by lesser curvature of the stomach and the posterior wall of the duodenum, endotypes 2A, 2C and 3 according to Forrest, the level of red blood cells, urea and general blood protein. The developed scale demonstrates a better prognosis of rebleeding than the Glasgow-Blatchford score and Rockall score (AUROC for the new scale is 0.88 with 95% CI: 0.836-0.924, for mGBS - 0.764 with 95% CI: 0.692-0.837, for RS - 0.759 with 95% CI: 0.688-0.830). The second study found that “difficult” localization of an ulcer (subcardial stomach, duodenal bulb) increases the risk of rebleeding after endoscopic hemostasis (OR = 25.4, 95% CI = 2.6 - 244.3).

Conclusion. Peptic ulcer bleeding remains an urgent problem today. One of the reasons for unsatisfactory  treatment results is a rebleeding. Stratification of the risk of rebleeding should be an important component in the complex of diagnosis and treatment of such patients, influencing the choice of therapeutic tactics.  

The quality of medical care in the plastic surgery profile is criticized. To assess and ensure the quality of medical care at the patient level, the use of the categories of the international classification of functioning, disability and participation allows. Under the auspices of WHO, sets of classification categories are formed for certain diseases and conditions, but their number is limited. A number of studies confirm the acceptability of the generated sets of classification categories for assessing conditions that are similar in terms of functioning and activity  restrictions, as well as the identity of the sets of classification categories with the results of functioning that patients would like to see after medical care. In this regard, the purpose of this study was to determine the acceptability of a set formed for breast cancer in aesthetic breast plastic surgery.

Materials and methods: the survey involved 75 women who had undergone aesthetic breast surgery. The average age of patients is 34.7±7.15 years. The survey was conducted in the form of interviews with patients during consultations before the operation, on the 1st and 6th day after the operation. The respondents were given a free form of indication of what kind of functioning, activity and participation it is important for them to have or recover from surgery within a month. After creating a list of expected results, respondents are asked to rank their significance from 0 to 10. Each response was compared with the set categories of functioning for breast cancer and other categories from the full version of the international classification of functioning, disability and health. A frequency analysis of the choice of categories relative to the number of patients for individual interviews and the sum of three interviews was performed, and the average rank of significance of  the categories of the considered set and additional classification categories was calculated and compared. 

Result: All respondents had different list of expectations before and after the operation. All patients in the sum of three interviews indicated expected results identical to the structure “reproductive system” (s630), the function “feeling pain” (b280) and the activity “washing” (d510). More than half of the respondents indicated expected results that are identical to the following categories: dressing (d540) (94.7%), intimate relationships (d770) (82.7%), lifting and moving objects (d430) (76.0%), appetite (b1302) (70.7%), changing body posture (d410) (68.0%), performing daily routines (d230) (60%), overcoming stress and other psychological loads (d 1240) (58.7%), managing transport (d475) (54.7%), sports (d9201) (52.0%). The respondents did not indicate the expected results that would be identical to the seven categories in the ICF set: volitional and motivational functions (b 130), sleep function (b134), self-perception and sensation functions in time (b 180), immune system functions (b 435), immune system structure (s420), shoulder area structure (s720), family relations (d760). In addition to the categories of the set under review, an additional 14 categories were identified that were identical to the expected results. The significance of expected results that are identical to the categories of the considered set for respondents is the same (t=1.3 p=0.21) with results that correspond to additional categories.

Conclusion: a set of categories for breast cancer is not acceptable for use in aesthetic breast plastic surgery.

Background: Gastrointestinal stromal tumors (GISТ) have recently been of the greatest interest among tumors of the gastrointestinal tract of mesenchymal origin due to the complete absence of a specific clinical picture. Surgical tactics in the treatment of GISO patients is the main one and does not raise any doubts, but, despite this, there are many controversial issues in choosing the optimal nature and scope of surgical treatment for localized and locally common forms of GISТ.

Aim: is to evaluate and compare the results of treatment of patients with GISТ of the upper gastrointestinal tract using open and laparoscopic surgery.

Materials and methods: The basis of the work is the results of the examination and treatment of 68 GIS patients of various age groups observed from 2012 to 2018. The study was performed in the form of a prospective two-center randomized patient with an assessment of the results of diagnosis and treatment. The first group consisted of 33 patients who underwent traditional surgical surgery, the second - 35 patients who underwent laparoscopic surgery. Postoperative complications were evaluated on a Clavien-Dindo scale.

Results: Lethal outcomes in group I and group II were not observed. When assessing postoperative complications, it was revealed that in group II complications of the I and III b degree on the Clavien-Dindo scale are 2 times less than in group I. In group I, 4 (12.1%) complications of the IIIb degree on the Clavien-Dindo scale and 2 (6.0%) complication of the first degree on the Clavien-Dindo scale (the total share of complications was 18.1%), and in group II only 2 (5.7%) complications of the III b degree on the Clavien-Dindo scale were revealed. The time for performing atypical gastric and bowel resection in group II compared with group I is 1,3 and 1,1 times less, respectively, but when performing pancreato-duodenal resections in group I, the results are better than in group II - in 1,25 times.

Conclusions. Minimally invasive surgical interventions for GISТ of the upper gastrointestinal tract are associated with a shorter time of surgical intervention, the amount of blood loss during surgery and a reduction in the patient’s hospital stay.

Background. One of the main factors that reduce the quality of life in patients after surgery for inguinal hernias is the recurrence of the disease and the development of chronic pain syndrome.

Material and methods. The results of surgical treatment of 1897 patients with inguinal hernias who underwent laparoscopic hernioplasty using the TAРР method were analyzed. The aim of the study is to determine the relationship between the type and size of the mesh, as well as the technical features of surgical intervention, with the probability of developing chronic pain syndrome and recurrent inguinal hernia. Group 1 – 842 patients who underwent TAРР using the ProGrip ™ self-fixing mesh, group 2 – 1054 patients operated using the TAРР method using the vypro II light composite mesh.

Results. In group 1, relapse occurred in 1 out of 842 patients (0.12%) when using a mesh area of less than 120 cm2, in group 2 (control), relapses were observed in 7 out of 1054 patients (0.66%), while even a relatively large mesh size (more than 140 cm2) did not always guarantee the absence ofrecurrence. The
cause of recurrence is a shift of the lower edge of the mesh up, migration of its medial or lateral edge into the  newly formed hernial canal due to insufficient size or fixation. Chronic pain syndrome was detected in 1 patient of the main group, whereas in the control group of such patients there were 13 for 1054 observations. The causes of this complication are directly related to the method of fixing the mesh: direct contact of a metal brace with a nerve twig or the development of a single-tissue scar in the area of the intracorporeal suture or a fixing element.

Conclusions. A self-fixing implant of sufficient size (10x15 cm), which provides “sticking” of the mesh over the entire surface, reliably protects the patient from both the development of chronic pain syndrome and recurrence of the disease.

Introduction: Мucinous carcinomas are aggressive malignant tumors of the pancreas. They rarely reach sizes larger than 4-5 cm. Demonstration of a clinical case of performing distal pancreatic resection in a patient with mucinous adenocarcinoma. A special feature of the case is the size of the tumor up to 15 cm.

Materials and Methods: patient N., 35 years old, was admitted to the surgical Department for planned surgical treatment in December 2019. He was diagnosed with a neoplasm of the tail of the pancreas

Results: The patient underwent a planned operation-laparoscopic distal resection of the pancreas. Intraoperatively, the tail of the pancreas is represented by a neoplasm up to 15 cm in diameter, of a dense consistency, soldered to the surrounding tissues. The pathohistological conclusion was consistent with
mucinous cystadenocarcinoma.

Discussion: There is relatively little information in the literature about mucin-producing carcinomas of this size and methods of their laparoscopic removal. Such cases require further study.

Conclusion: In the presence of mucinous cystadenocarcinoma of the tail of the pancreas with a diameter of 15 cm, laparoscopic distal resection of the pancreas is technically feasible, which made it possible to perform a radical operation, speed up the patient’s rehabilitation despite the volume of the operating injury. The current development of laparoscopic surgery has not exhausted its potential and requires improvement in new sections of surgery, including in interventions on the pancreas.

Surgical treatment of hernias of the anterior abdominal wall remains an urgent problem, since hernia-bearing occurs in 4-7% of the world’s population and there is no tendency to reduce the number of such patients.

The aim of the study is to conduct a comparative analysis of traditional and non-tight methods of hernioplasty with hernias of the anterior abdominal wall, improve hernioplasty methods, the frequency of relapses and complications in the near and long-term postoperative periods.
The problem associated with overweight has existed for a very long time, but nevertheless, advances in the treatment of obesity are very small and the number of patients with morbid obesity is growing. According to the  WHO, over 30% of the world’s population suffers from overweight. All factors causing excess body weight  lead to a weakening of the muscular aponeurotic framework with subsequent formation of abdominal ptosis. For plastic surgery of the anterior abdominal wall in modern surgery in patients with morbid obesity, non-tensioning methods are more preferable, since according to the studies of many authors with stretch hernioplasty, the recurrence rate reaches 20-63%, while in non-tension plastic surgery it is 8-30.3%.

The aim of the study is to improve the quality of life and the results of surgical treatment of patients with morbid obesity. 

The material of this study was 62 patients with morbid obesity who were hospitalized in the period from 2010 to 2019 in the surgical department No. 2 of the Republican Clinical Hospital in Nalchik on the basis of Hospital Surgery of KBSU. In our work, all patients had ptosis of the anterior abdominal wall of III (n = 44) and IV (n = 18) degrees of obesity. The patient underwent surgery to eliminate the skin-fat apron and non-tension abdominoplasty using a polypropylene mesh, in the presence of cholelithiasis, a cholecystectomy was performed.

As the results of the study showed, in 38.5% of patients there were some complications of an inflammatory nature, with somewhat more complications such as seromas, lymphorrhea and, as a result, purulent-inflammatory complications. This is due to the fact that patients underwent abdominoplasty in which a wide mobilization of the subcutaneous fat layer is performed and, accordingly, the risk of developing seromas and lymphorrhea is increased. Patients were hospitalized from 16 to 28 days.All patients were discharged in satisfactory condition with recommendations. In terms of the functional effect, due to the optimal scheme of preoperative preparation and abdominoplasty, an improvement in external respiration was noted, and there were no complications from the cardiovascular system. All patients were satisfied with the obtained aesthetic result. 

Objective: to evaluate surgical safety and functional effectiveness of pouch jejunogastroplastic as a physiological method of reconstruction of the upper digestive tract after gastrectomy.

Methods: in the period 2013-18, at the Scientific and Research Center for Surgery named after A.V. Vishnevsky 30 patients after gatrectomy was performed a jejunogastroplastic reservoir (jejunal pouch) in the original technique. Of these, 25 (83.3%) patients were operated due to stomach cancer, and 5 (16.7%) due to operated stomach disease. Average age of patients was 54 years, male-20 (66.7%), female-10 (33.3%). After the resection stage of jejunal segment, 40 cm length resection of 3rd or 4th pairs of mesenteric arteries was done. Further it was mobilised into the upper section the abdominal cavity through the window into the mesocolon, restored the cavity of small intestine by an end-to-end anastomosis. The intestinal segment was divided in half by incomplete dissection of mesentery till the main supply vessel and from two split segments formed an isoperistaltic reservoir, joining them with each other as “side to side” for 10 cm in a single-row twisted seam. The reconctruction was completed by the formation of double-row duodenal-jejunal anastomosis and single-row esophagojejunal anastomosis.

Results: surgical complications in early postoperative period occurred in 2 (6.6%) patients: one had partial esophagojejunal anastomosis leak, the other had subphrenic hematoma. Fatalities during the period of hospitalization was not observed. At the end of the study under observation 23 (76.6%) of 30 patients remained. Long-term examination of patients revealed in 13 (56.6%) good, 7 (30.4%) - a satisfactory result.

Conclusion: the obtained results of the performed operations prove the viability of jejunogastroplastic reservoir (jejunal pouch) as a physiological method for the restoration of upper digestive tract after gastrectomy. Able to partially replace the loss of gastric function, creating conditions for the compensation of the digestive system bringing activity closer to the physiological norms.

Surgical treatment of hernias of the anterior abdominal wall remains an urgent problem, since hernia-bearing occurs in 4-7% of the world’s population and there is no tendency to reduce the number of such patients. The aim of the study is to conduct a comparative analysis of traditional and non-tight methods of hernioplasty with hernias of the anterior abdominal wall, improve hernioplasty methods, the frequency of relapses and  complications in the near and long-term postoperative periods.
The work was performed at two medical bases of the Department of Hospital Surgery, Faculty of Medicine,  Kabardino-Balkarian State University named after H.M. Berbekov and the surgical department (Department of Angiosurgery) of the Republican Clinical Hospital. The study was conducted on the basis of a retrospective study of case histories of 258 patients who were between 2010 and 2019. performed non-tension and tension hernioplasty for hernias of the anterior abdominal wall.
As a result of this study, it was revealed that unrestricted herniopalastic surgery using a polypropylene mesh is the  method of choice, especially for gigantic and complicated hernias, which is confirmed by earlier activation of patients, shorter hospital stay, the absence of severe pain syndrome, stopping only with narcotic analgesics, less complications and the frequency of infection of postoperative wounds. The use of endovideo surgical methods also yielded positive results, but in the case of gigantic postoperative and recurrent ventral hernias, especially with a complicated course, their use is not always possible. In this connection, open surgical methods of hernioplasty remain relevant and their further improvement is required. The use of non-tension hernioplasty has not only a good clinical effect, but also economic feasibility.

The present article reviews the literature and briefly describes the scientific and practical achievements of Russian surgery in the area of breast reconstruction after radical surgery. The relevance of the problem studying is explained by its international character, as well as lack of research on common criteria allowing to choose the method of breast reconstruction after radical surgery accurately. At the same time, the need for surgical intervention is indisputable, meaning there are organizational, surgical and other types of risks. The authors emphasize the necessity to study the most effective applications of surgical methods in combination with measures to preserve or improve the aesthetic result, which has an undoubtedly negative affect on the mental state of patients. The process of studying the problem has been carried out continuously over the past few decades both at internal and global levels, as evidenced by the time range of the literature reviewed by the authors. However, to date, there are no unified algorithms for the treatment of breast cancer which take into account a variety of external and internal factors, including quality of life, genetic and ethnic factors, aesthetic result, mental state, etc. Thus, the article highlights the importance of working out a number of scientific and practical measures further to obtain an effective solution based on a comprehensive study of the problem.

Urinary incontinence is one of the most common female urological diseases, which adversely affects the quality of life of patients. Using a synthetic tape is the gold standard in treating this disease. However, the lack of standards for positioning the synthetic tapes and ineffective methods for controlling the tape tension can lead to various intra- and postoperative complications. This article presents observations and studies on the effectiveness of surgical treatment of urinary incontinence in women, as well as possible complications and intraoperative methods for controlling the tension of the synthetic tape.

The aim of the research: the aim of the research was to describe modern minimally invasive technologies for the diagnosis and treatment of such a formidable complication in biliary surgery as hemobilia. Hemobilia is a bleeding into the lumen of the biliary tract, due to the presence of a communication between the blood vessel (more often - the artery) and the biliary duct. Despite certain difficulties in timely diagnosis, patients require mandatory, with rare exceptions, invasive treatment in order to prevent possible relapses and complications. The doctor should, if possible, limit himself to minimally invasive intervention to achieve optimal curation and patient recovery results in the shortest possible time.

Materials and methods: various open-access available resources such as pubmed, elibrary, google scholar were analyzed on request of hemobilia, minimally invasive treatment. 

The results of the study: there was given a brief description of the advantages, as well as possible disadvantages of the available types of minimally invasive curation of hemobilia.

Conclusion: today, transcatheter arterial embolization should be considered as the generally accepted “gold standard” in the supervision of patients with bleeding in the biliary, however, there are a whole host of alternative methods, both for additional therapy and for the main tactics in treating patients in non-standard clinical cases in the arsenal of minimally invasive intervention surgery. Such a variety of minimally invasive technologies in the supervision of this pathology allows us to achieve positive treatment outcomes with minimal access trauma, in any variant of the hepatobiliary system anatomy, as well as in the case of critical complications.

Aim: to evaluate the effectiveness of the modernized Bates-Jensen` scale as a method of objectify the choice of treatment for bedsores in patients with brain damage who are in a chronic critical condition.

Methods: a survey of patients with severe brain damage and grade III DL who underwent reconstructive surgery – autodermoplasty (ADP) for the period 2017-2019 was conducted. A total of 30 people: 23 (76.7%) of them men and 7 (23.3%) women aged 27 to 63 years. Depending on the outcome of the operation 2 groups were formed: 17 patients with a positive outcome of the intervention and 13 patients with a negative outcome of ADP (rejection of the flap, further progression bedsore). For a quantitative assessment of the healing dynamics we used the Bates-Jensen` scale and its modernized analogue supplemented by 3 new criteria. Scoring and statistical analysis of the results showed that a total score of ≥50 according to the adapted Bates-Jensen` scale at the time of hospitalization should be considered an absolute contraindication for ADP. A predictor of a positive outcome for ADP is ≤40 points by adapted Bates-Jensen` scale after two weeks of conservative therapy (p<0,05).

Conclusion: The modified Bates-Jensen` scale allows for a comprehensive assessment of pressure sores, monitoring of the wound hilling process and objectifying cure tactics.  

The main scientific and practical achievements of Professor A.A. Bobrov are presented. The life path of the scientist is analyzed. It is shown that during the Russian-Turkish war, he was at the front (1877), then on a scientific trip abroad. Since 1884 A.A. Bobrov-associate Professor, and since 1885— Professor of the Department of operative surgery and surgical anatomy of the Moscow University and at the same time (since 1884) consultant at the surgical Department of the Basmanny hospital. It is shown that since 1893 he headed the faculty surgical clinic of Moscow University, where he remained a Professor until the end of his life. The textbooks of A.A. Bobrov “Dislocations and fractures”, “Course of operative surgery and surgical anatomy”, which have passed several editions, are marked. One of the most important services of A.A. Bobrov to Russian surgery is the continuation and development of the ideas of the brilliant N.I. Pirogov in the field of surgical anatomy. Well-known methods of hernia and liver Echinococcus surgery according to A.A. Bobrov; he proposed a device for subcutaneous fluid injection, which bears his name. It is emphasized that A.A. Bobrov was a member of the Society of Russian doctors in memory of N.I. Pirogov, a member of the Moscow surgical society, one of the initiators and organizers of congresses of Russian surgeons. It is noted that at the initiative of Professor A.A. Bobrov, a sanatorium was established in the Crimea (Alupka), which currently bears his name, for the treatment of bone tuberculosis in children.

The article presents the main milestones of scientific and practical activity of outstanding Soviet surgeons Nikolai vardenovich antelava (1893-1970) and Nikolai Ivanovich Kukudzhanov (1896 – 1970). Little-known facts from the life of scientists are noted. It is shown that From 1925 to 1935, N.V. Antelava was in charge of the Sukhumi city hospital. During the great Patriotic war (1941-1945), he worked in a number of evacuation hospitals in Tbilisi. From 1949 to 1957-chief surgeon of the Ministry of health of the Georgian SSR. It is emphasized That N.V. Antelava is a pioneer of thoracic surgery in Georgia. On his initiative, surgical departments were organized in a number of tuberculosis sanatoriums. In Tbilisi, he created the center for thoracic surgery — a research laboratory for thoracic surgery. In the clinic run By N.V. Antelava, for the first time in Georgia, operations were performed under hypothermia, on a “ dry “ heart, for congenital and acquired defects. N.V. Antelava is the author of more than 200 scientific papers on various issues of General and thoracic surgery, including 13 monographs. It is noted that the monograph “surgery of the lungs and pleura” was awarded the S.P. Fedorov prize (1938).
Professor N. I. Kukudzhanov was an outstanding surgeon, Clinician, scientist and practitioner. It is noted that in 1939 – 1962 he was the chief doctor of the Transcaucasian military district. From 1962 to the end of his life, N.I. Kukudzhanov was a scientific adviser at the Tbilisi military hospital and simultaneously from 1945 to 1970. - head of the military surgical Department of the Tbilisi Institute of advanced medical training (TGIDU). It is emphasized that in 1969 the monograph “Inguinal hernias” was published, which is still a fundamental work written By N.I. Kukudzhanov on the basis of many years of experience.