Introduction: the purpose of this work was to study the immediate results of treatment and develop an algorithm for using different access options for urgent colon operations.
Material and methods: the study performed a retrospective analysis of the results of treatment of 89 patients with various diseases of the colon, operated on urgently and urgently. All patients were divided into 2 groups: 31 patients (the main group) - operated from laparoscopic access, 58 patients (the comparison group) - from laparotomic access. The groups were comparable in age, frequency, and type of underlying and concomitant diseases, but differed in gender, risk class of anesthesia (ASA), and incidence of complications of the underlying disease.
Results: the main indications for emergency or urgent surgery were acute intestinal obstruction (16.2% vs. 53.5%), intestinal bleeding (41.9% vs. 6.9%) and peritonitis (22.6% vs. 29.3%). The average duration of operations did not depend on the type of access used. There were no significant differences in the frequency of postoperative complications between patients of both groups (9.7% vs. 6.9%). The use of laparoscopic access resulted in a statistically significant reduction in the recovery time of intestinal peristalsis (2.1±0.4 vs. 3.8±0.9 days), and was accompanied by a significant reduction in the time of use of analgesics (2.7±0.6 vs. 4.6±1.2 days).
Conclusion: the use of laparoscopic approach for urgent diseases of the colon does not increase the duration of interventions and frequency of postoperative complications, but is accompanied by a shortening of postoperative intestinal paresis and reduced need for analgesics. The developed algorithm for selecting surgical access allows increasing the number of patients with urgent colon diseases who can be operated minimally invasive.

Introduction. Laparoscopic cholecystectomy is the «gold standard» of the treatment for patients with benign gallbladder diseases. In recent years, there has been a trend towards a decrease in the number of incisions for surgical intervention to single-port technologies.
Material and methods. In our study the results of single-port laparoscopic cholecystectomy at 300 patients were compared with standard laparoscopic cholecystectomy at 1150 patients.
Results. The duration of the laparoscopic cholecystectomy was 40 (35—60) minutes, the duration of the SILS was 55 (45—65) minutes. The conversion of SILS for «traditional» 4-puncture laparoscopic intervention was noted in 2.3% of patients, for open cholecystectomy in 0.3%, after LCE conversion of laparoscopic access to laparotomy was performed in 0.7% patients. Morbidity after laparoscopic cholecystectomy was 0.8%. Morbidity after SILS was 1%. Mortality after laparoscopic cholecystectomy was 0.17% (as a result of massive pulmonary embolism). Mortality after SILS was not. Pain syndrome after laparoscopic cholecystectomy was 6 (4—7) points, after SILS — 4 (3—5) points (p <0.05). Satisfaction of the results of treatment after laparoscopic cholecystectomy was 95%, after SILS — 98% (p <0.05). Duration of the postoperative hospital-stay after laparoscopic cholecystectomy was 3 (2—5) days, after SILS — 1 (1—2) days (p<0.05).
Conclusion. It was shown that SILS for various forms of cholelithiasis allows achieving optimal cosmetic results, moderate postoperative pain syndrome, rapid postoperative rehabilitation of patients, as well as an increase in overall satisfaction with treatment in patients compared with standard laparoscopic cholecystectomy. In addition, when performing SILS, it is possible to switch to traditional LCE in case of technical difficulties during the operation.

Introduction. Malignant distal biliary obstruction is a common manifestation of tumors of the periampullary area.
Material and methods. In Botkin hospital (Moscow) from 2010 to 2019, percutaneous biliary drainage (PBD) was performed in 348 patients with malignant distal biliary obstruction (MDBO). The patients were divided into 2 groups: group 1 — 276 right-sided PBD (RPBD); group 2 — 72 left-sided PBD (LPBD). The causes of MDBO: group 1/group 2 were pancreatic cancer 194 (70.3%)/51 (70.8%), extrahepatic cholangiocarcinoma 49 (17.7%)/12 (16.7%), MDP cancer 9 (3.3%)/3 (4.2%), metastatic cancer 24 (8.7%)/6 (8.3%). Patient characteristics: age group 1 68.2±4.1 years, group 2 71.7±5.5 years; gender (m/f) group 1 109/157, group 2 31/41; ECOG group 1 2.4±0.2 points, group 2 2.1±0.5 points; average bilirubin level group 1 251±12.8 μmol / l, group 2 236±22.3 μmol / l. The duration of procedure: group 1 28.4±4.1 min, group 2 — 42.1±8.3 min (p=0.041). Clinical success 227 (82.2%) RPBD and 63 (87.5%) LPBD (p=0.122). The pain syndrome was higher in patients of group 1 (p=0.039). Complications developed in 85 (30.8%) patients in the RPBD group and in 27 (37.5%) in the LPBD group (p=0.308).
Discussion. Were no significant differences found in the duration of fluoroscopy, total bilirubin and postoperative complications. The duration of the procedure in the group LPBD was higher (p=0.041). The negative change in the quality of life (according to the global and functional scales p=0.045 and 0.036, respectively) was higher in the group RPBD.
Conclusion. Antegrade external drainage of the bile ducts is a highly effective procedure for decompression of the biliary tract in ZDBO.

This article examines the definition of lymph circulation in the intestinal mesentery system in normal conditions and in the UC model, as well as the management and treatment of patients with ulcerative colitis using lymphotropic therapy in the postoperative period. The aim of this work is to study and evaluate the non-refuting value of lymphotropic therapy in patients in the complex treatment of UC in the postoperative period.
Material and methods. In several experiments on animals - such as dogs, we have created a model of ulcerative colitis, and at the same time, before and after the creation of the model, we studied the lymph circulation in the intestinal mesentery. Based on the results of experimental studies, lymphotropic therapy was applied in clinical conditions in the complex treatment of ulcerative colitis in the postoperative period in 54 patients. To compare the results of lymphatic therapy, a control group of 43 patients was created who received conventional conventional treatment in the postoperative period.
Results. When using lymphotropic therapy in the complex treatment of ulcerative colitis, the number of intestinal complications in the postoperative period is significantly reduced and the patient's stay in the hospital is reduced.

Relevance: this article examines the definitions of lymph circulation in the intestinal mesentery system in normal conditions and in the UC model, as well as the management and treatment of patients with ulcerative colitis using lymphotropic therapy in the postoperative period. The aim of this work is to study and evaluate the non-refuting value of lymphotropic therapy in patients in the complex treatment of UC in the postoperative period.
Material and methods — in serial experiments on animals — dogs, in an experiment, we have created a model of ulcerative colitis, and at the same time, before and after the creation of the model, we studied the lymph circulation in the intestinal mesentery. Based on the results of experimental studies, in a clinical setting, lymphotropic therapy was used in the complex treatment of ulcerative colitis in the postoperative period in 54 patients. To compare the results of lymphatic therapy, a control group of 43 patients was created who received conventional conventional treatment in the postoperative period.
Results: when using lymphotropic therapy in the complex treatment of ulcerative colitis, the number of intestinal complications in the postoperative period significantly decreases and the patient's stay in the hospital is reduced.

Introduction. The aim of this work is to study the immediate and long-term results of treatment of ventral and incisional hernias using the laparoscopic IPOM technology.
Materials and methods. A comparative retrospective-prospective cohort study of the results of surgical interventions using minimally invasive laparoscopic IPOM (intraperitoneal onlay mesh) plasty and open Sublay plasty was performed in 144 patients who sought medical help for ventral hernia, with a hernia orifice size up to 130 cm2. All patients were employed between the ages of 22 and 56 years. Of these, 63% are women and 37% are men. The average age of the patients was 46±7.3 years.
Discussion. An ultrasound examination of the anterior abdominal wall at the preoperative stage made it possible to avoid vascular damage during the operation and, as a consequence, hematomas in the early postoperative period. The study showed that the use of laparoscopic hernioplasty reduces the number of seromas in comparison with the control group by half, significantly reduces the risk of hematomas and infiltrates. The use of IPOM plastic statistically significantly reduces the duration of the operation, the time of restoration of the intestinal motor-evacuation function. There was a significant decrease in the duration of taking analgesics and the length of hospital stay. The analysis of the restoration of working capacity was carried out depending on the method and dimensions of the hernial defect. The ability to work was restored in all cases. It is noteworthy that there was no significant difference in the timing of mental and light work. Performing work of moderate severity was possible after 2.5–3 weeks in patients of the first group, and heavy work after 1.5 months. In the patients of the control group, moderate and hard work was possible only by 2–2.5 months.
Conclusions. 1. The use of the modified method of intraperitoneal laparoscopic hernioplasty, IPOM, is a safe method of treating patients with ventral and incisional hernias with hernial orifice sizes W1-W2; it can reliably reduce the risk of postoperative seroma formation by almost 2 times, as well as the formation of anterior abdominal wall hematomas and infiltrates. The use of laparoscopic technologies makes it possible to reduce postoperative pain syndrome, avoid hematomas of the anterior abdominal wall, reduce the length of hospital stay, and reduce the need for the administration of parenteral analgesics (p <0.05).
2. The most significant advantages of IPOM hernioplasty over «open» hernioplasty in rehabilitation and restoration of labor activity in people engaged in moderate and hard work (p <0.0001). No significant changes in the timing of the recovery of mental and light labor were found.

Introduction. In the absence of non-invasive methods morphological verification is required to establish a diagnosis of diseases of pulmonary system. The most importance is the early diagnostic HIV-infected patients.
The aim of this work is to study the results and safety of surgical diagnostics of patients with undifferentiated pulmonary and intrapleural processes not diagnosed with traditional examination methods.
Materials and methods. In the period 2014—2019, 404 diagnostic thoracic interventions were performed at the Clinic 2 of Moscow Research and Clinical Center for Tuberculosis Control to verify the diagnosis, 111 of them were HIV-infected.
Results. Tuberous tumor-like rashes on parietal pleura were in 69.4% of patients with pleurisy during thoracoscopy. In 65% of cases of histological examination verified the formation of classical granulomas. Acid-fast bacilum were identified in 48%. DNA of tuberculosis mycobacteria in altered pleura was found in 84%. Resistance to rifampicin was found in 23.5% of patients. In six cases patients without HIV defined pleural mesothelioma. In the group of lung resection 40% of patients confirmed pulmonary tuberculosis, 15.7% of patients had benign lung tumors, 20.2% of patients had malignant lung tumors, 23.8% had rare and atypical pathological pulmonary processes.
Conclusion. Surgical diagnostic methods of pulmonary and pleura diseases is safe, effective and does not lead to a significant number of complications and mortality among patients with HIV infection, regardless of the initial immune status. The low detection of the pathogen in the exudate allows considering thoracoscopy biopsy to be the only reliable diagnostic method for pleurisy which also has a medical character. Using the T-SPOT®.TB test system of pleural fluid increases the clinical sensitivity to 91.3% compared with the analysis of peripheral blood (83.7%).

Phlegmon of the neck is one of the most severe forms of soft tissue infection in the practice of surgeons, otolaryngologists, thoracic surgeons, and dentists. A wide range of phlegmon causes, peculiar topographic and anatomical relationship between the interfacial compartments create difficulties in timely clinical and topical diagnosis, adequate surgical treatment and prognosis for a disease.
There is still no generally accepted classification of neck phlegmon. There are various criteria for classifying: the cause of disease occurrence, topographic and anatomical locations of the abscess, the prevalence of the pathological process, microbial pathogens, complications, etc.
The paper presents the frequency and causes of neck phlegmon. Various approaches to the classification of this pathological process are considered.
One of the ways to create a classification is to use a score assessment of the disease severity and patient's condition, which allows to form a therapeutic and diagnostic algorithm and predict the course of the disease. Other criteria can be also used for scoring: gender, age, cause and duration of the disease, the prevalence of the pathological process, the presence of complications and concomitant pathologies.
Creating a modern classification is a complex task, and the use of scoring scales requires searching for statistically significant criteria that affect the course and outcome of the disease.

Introduction. This article describes a method for applying the limitation of the surgical field with the simultaneous creation of a squeezing rope. The presented method allows during surgical treatment of infections of the hand, to restore the functioning of the hand as efficiently as possible, thereby allowing the patient to maintain their ability to work in areas directly related to it.
Materials and methods. The article gives a brief description of standard surgical treatment. A statistical comparison of two groups was carried out, in one of which the classical method of surgical aid was used, and in the other using the delimitation of the operative field with the simultaneous creation of squeezing tourniquet for the surgical treatment of purulent-inflammatory diseases of the hand. Based on a comparison of which the advantages of the methods used in different groups could be identified, the disadvantages and ways to minimize them for the patient were examined.
Results. The key advantages of the method presented in the article are: neighboring areas of the hand are reliably isolated from the operation area, which excludes their contamination in the treatment of surgical infections or infection of a conditionally «clean» wound; squeezing tourniquet minimizes blood loss and creates better conditions for visualizing anatomical formations; better patient limb control minimizes the risk of impaired sterility of the surgical field; causes less discomfort to the patient.
Conclusion. The proposed method of treatment makes it possible to better visualize the affected structures, achieve less blood loss and a small number of postoperative complications. During the dynamic monitoring of patients and tracking long-term results, our method allowed us to reduce the time of inpatient treatment and contributed to the early implementation of rehabilitation measures for rehabilitation measures.

Introduction: A correlation was found between the length of chromosome telomeres as a predictor of life expectancy and obesity with metabolic manifestations. The aim of this study was to evaluate the changes of telomere length as an indicator of life expectancy, changes in body mass and other components of the metabolic syndrome after weight loss.
Methods: the study is designed as an interventional, prospective, controlled, a three-arm randomized controlled trial at a single center including 60 participants. The first group is composed of patients who have undergone stapleless laparoscopic one anastomosis gastric bypass with an obstructive stapleless pouch and anastomosis. The second group of patients underwent staple use laparoscopic mini-gastric bypass-one anastomosis gastric bypass. The patients in the third group received non-surgical weight loss therapy, including a hypocaloric diet with energy restriction. Primary outcome measures included changes in the length of leukocyte telomeres. Secondary outcome measurements included changes in body mass index, other components of the metabolic syndrome.
Results: 60 patients were randomized and allocated for intervention: first group (n=20), second group (n=20), third group (n=20). The surgical groups (first, second) after 12 months postop had the greatest weight loss compared to third group with average changes BMI. The surgical groups also had the most significant change in telomere length.
Conclusions: Compared with the non-surgical treatment of obese patients with metabolic syndrome, bariatric surgery leads to greater body weight loss and a significant increase in telomere length and greater resolved metabolic syndrome.

The aim of this study was to compare the results of mini-gastric bypass surgery with different lengths and widths of the gastric pouch.
Methods. The author conducted a prospective clinical study with a random distribution of patients into comparison groups. The study included 500 patients who underwent laparoscopic mini-gastric bypass surgery — one anastomosis gastric bypass (MGB—OAGB). The first group included 248 patients, where the standard Carbajo MGB—OAGB technique with a long and wide gastric pouch was used. And in the second group there were 252 patients, where a shortened and narrower small stomach was created.
Results. The second group showed a more pronounced bariatric effect compared to the first group. After surgery, the change in body mass index in the second group was 16.1±5.7 kg / m2 compared to 12.4±3.08 kg / m2 in the first group (p <0.01). There were no complications after MGB—OAGB in the form of biliary entero-gastric reflux. There were also fewer cases of peptic ulcers of gastroenteroanastomosis. The average number of stapler cassettes per operation in the second group was less: 5.4±0.4 reloads versus 7.2±0.9 reloads in the first group (p <0.05).
Conclusions. Implementation of a narrower and shorter along the length of the gastric pouch with MGB—OAGB leads to an increase in the bariatric effect, while the likelihood of developing marginal ulcers of gastroenteroanastomosis and biliary reflux decreases. And also the need for reloads for the stapler is reduced.

The last 10 years have seen an exponential increase in the number of obese patients. In most countries, over 30% of the population is overweight and obese. Bariatric surgery is the most effective treatment for morbid obesity today. The number of bariatric interventions performed annually is growing and today exceeds 760 thousand per year. Over the past 7 years, the most commonly performed bariatric surgery has been laparoscopic sleeve gastrectomy. Despite the huge experience in bariatric surgery and the continuous improvement of staplers and dissections tissue technologies the complications still exists. The most serious complication after performing a laparoscopic sleeve gastrectomy is a leak of staple line. The article presents current view on the causes, diagnosis, prevention and treatment tactics for patients with the leak after sleeve gastrectomy.

Introduction. Urea disease is one of the most common diseases in the world, affecting almost 3% of the population, mainly people of working age from 40 to 50 years, which determines the relevance of a comprehensive study of this disease. The aim of the study was to study the mechanism of endothelial dysfunction formation in the complicated course of the postoperative period in patients with urolithiasis.
Materials and methods. The study included 90 patients with urolithiasis who had operational interventions in the urology department of the Russian Railways-Medicine Clinical Hospital of Krasnoyarsk between 2017 and 2019. The age of patients with urolithiasis in our study was from 19 to 82 years, with a median age of 54 [37; 69] years.
Results. The risk of postoperative complications in urolithiasis increases with increasing indices of terminal and total blebbing of plasma membrane of lymphocytes and increasing expression of lymphocytes activated by CD 31 and CD 38.
Conclusion. Patients with a predicted risk of developing complications in the postoperative period need a choice of treatment tactics and postoperative therapy aimed at preventing the development of a complicated course of the disease.

Sharp ingested foreign bodies in the digestive tract are quite a rare find in the clinical practice of urgent abdominal surgery. Such cases are more likely to be found among mental, observed in mentally ill patients, prisoners, elderly and drug addicts. Accidental cases are actually quite seldom. Sharp foreign bodies are mainly ingested on purpose due to the changed mental state. However, this does not make them any less dangerous. The way the objects pass through the digestive tract strongly depends on their size and characteristics. The passage becomes slightly easier when a foreign body goes through the stomach. Most cases with a basic (uncomplicated) passage are insympathetic, which makes them very difficult to diagnose. According to Exner's reflex, sharp foreign bodies within the gut can travel freely, without any damage to the gastrointestinal tract by inhibiting the contractions of the overlaying muscle so that perforation will be avoided. The sharp edges of the foreign body irritate the mucous membrane causing the tightening of the mucous. That makes the object turn gradually to present its blunt edges, provided that the length of the object does not exceed the lumen of the intestine. The clinical observation shows the manifestation of the ‘needle’ reflex described by Exner in 1902, which allowed us to dispense with surgery and avoid complications, which in many cases are fatal.

In this case we describe multiple enteroatmospheric fistulas of gastrointestinal tract of patient after bariatric procedure. Also it presents surgical tactics that had caused development of enteroatmospheric fistulas. Started from initial bariatric procedure we described all mistakes of treatment of this patient and ways of correction of happened condition. Scheme of local treatment of enteroatmospheric fistulas with usage of active drainage of intestinal juice was decribed. This patient had gastrointestinal reconstruction after 4 month after latest surgical procedure. Full condition of gastrointestinal tract had been understood in process of operation: multiple «loops» made from small intestine, gastroenteroanastomosis leakage, formed gastrotransversoanastomosis. Resection of small intestine with enterocutaneus fistulas with full reconstruction were made. Also colostomy were made, which were closed a year after last operation. Mistakes we describe in this case were analyzed taking into account world literature of bariatric surgery and management of enteroatmospheric fistulas. In the conclusion we can say that very active surgical treatment can decrease condition of patients with multiple enteroatmospheric fistulas.

Breast cancer (BC) treatment remains a complex problem in modern oncology. Currently, there is a possibility of performing organ-preserving surgical interventions. Despite the rapid development of drug treatment for breast cancer, surgery for this disease takes the main place. When radical resection is contraindicated, a radical mastectomy is performed, which entails physical and emotional consequences, the most important of which are organ loss, loss of femininity, sexuality, attractiveness, and leads to irreversible changes in social life. Mental disorders in breast cancer patients attract the attention of many researchers [1, 2, 3]. For example, in the work of S.D. Galliulina showed high rates of effective disorders in the form of depression, shock and auto aggression [4]. Breast amputation, especially at a young age, is not only a physical disability, but also leads to psychological disturbances in more than 30% of women. According to the results of the socio-psychological status [4], these psychological disorders are difficult to drug therapy and the use of external prosthetic does not eliminate the depressive state in this category of patients. This article discusses the historical aspect of the diagnosis: breast cancer and options for reconstructive breast surgery. To address the issues of rehabilitation of patients with the absence of a mammary gland, methods of its reconstruction are currently successfully used, which not only restore the shape of the organ and eliminate the asymmetry of the body, but also have a proven effectiveness in restoring the psychological status and self-esteem of a woman [4,8].

Throughout the world, back pain affects a large part of the population. Degenerative-dystrophic diseases of the spine are one of the most important problems of modern medicine. The share of this disease affecting people in the most active social group is from 20% to 80% of cases of temporary disability.
The goal is to present the history of the development of surgical methods for the treatment of degenerative diseases of the spine.
Materials and methods. The literature presented in the PubMed, eLibrary and Cochrane databases is analyzed.
Results. This paper describes all types of surgical interventions used for degenerative diseases of the lumbar spine: decompressive, decompressive-stabilizing and reconstructive-stabilizing. The indications for each of the methods of operative aid are described. The results of decompressive interventions were compared: microsurgical, tubular and endoscopic microdiscectomies. Modern approaches to the lumbar spine are described and compared: PLIF, TLIF, XLIF, ALIF. Further, the paper describes the basic principles of reconstructive and stabilizing operations: measurement of vertebral-pelvic ratios, classification of vertebrotomies.
Conclusion. Endoscopic spine surgery is a prerogative in the treatment of degenerative diseases of the lumbar spine due to a shorter stay in the clinic, less tissue trauma, lower use of analgesics and rapid recovery. Decompression-stabilizing operations are currently used in patients without violation of the sagittal and frontal balances. The choice of the method of fixation (back, front or a combination of them) should depend on the experience of the clinic, the skills of the surgeon and the anatomical features of the patient. Vertebrotomies are performed only when there is a violation of the sagittal and frontal balance.

The main milestones of V.M. Mysh's life are analyzed. Since 1901 he was a Professor at the Department of General surgery, and from 1909 to 1931 was head of the Department of faculty surgery at Tomsk University. It is noted that V.M. Mysh in 1927 organized the Institute of advanced training of doctors in Tomsk, since 1932 he was the head of the Department of surgery of this institution. After transferring the University to Novosibirsk, he continued to head the Department of surgery until the end of his life and at the same time (since 1936) was the head of the Department of faculty surgery of the Novosibirsk medical Institute. It is noted that during the great Patriotic war V.M. The mouse was the main consultant of the evacuation hospitals of Novosibirsk. It is noted that V.M. Mysh has published more than 130 scientific papers, including manuals and monographs, on abdominal and thoracic surgery, Oncology, urology, bone and joint diseases, General and plastic surgery. It is shown that in 1912, he was the first in our country to perform a radical operation for alveolar echinococcosis of the liver, a two-stage transpesicular prostatectomy for prostatic hypertrophy. Mysh proposed a number of original interventions: ureteral transplantation according to a modified method, plastic surgery as a method of treating phimosis; restoration of mobility of the mandibular joint in its bilateral bone ankylosis, etc. Vladimir Mikhailovich, being one of the founders of the Siberian school of urology, as well as a mentor and teacher of outstanding clinicians, is rightfully recognized as one of the patriarchs of Russian surgery. The scientific priorities are analyzed and prominent surgeons of the school of V.M. Mysh are presented. Among his students were V.S. Levit, G.M. Mukhadze, M.S. Rabinovich, A.G. Savinykh, S.L. Schneider, K.N. Cherepnin, D.V. mysh et al. It is noted that the clinic of faculty surgery of the Novosibirsk medical Institute was named after V. M. Mysh.