Introduction: minimally invasive surgery is a priority area of medicine. It significantly reduce the surgical trauma, the duration of the operation and the number of complications. Laparoscopic surgeries are becoming central to the treatment of giant hiatal hernia and reflux disease. Laparoscopic elimination of hiatal hernia, cruroraphy, Nissen fundoplication with giant hiatal hernia is associated with a high risk of complications.
Materials and Methods: or the period from January 1, 2019 to October 1, 2020, 26 patients with giant hiatal hernia were operated in a surgical hospital. He underwent laparoscopic removal of the hiatal hernia, cruroraphy, and Nissen fundoplication.
Results: all patients were discharged home in satisfactory condition. There are no postoperative complications and deaths. According to the observation data, there are no recurrences of giant hiatal hernia in these patients. The period of stay of such patients in the hospital did not exceed 4 days.
Discussion: formidable complications can develop when performing these operations. The technical principles developed by us make it possible to safely perform laparoscopic elimination of the hiatal hernia, cruroraphy and Nissen fundoplication with giant hiatal hernia.
Conclusion: The clinical experience and the developed principles of performing laparoscopic elimination of giant hiatal hernia are presented. It is necessary to continue the study and systematization for this group of patients.

The aim of considered the implementation of soft tissue defects correction by means of autologous adipose tissue transplantation after liposuction surgery.
Materials and methods. The study was conducted by the authors from 2016 to 2020 and included 26 consecutive operations in female patients. The age limits of the patients ranged from 20 to 59 years. The preoperative body mass index of the patients was 17.4–26.5 kg/m², on average 21.6 kg/m² and was determined during the first application. Liposuction surgery was performed 1–3 times on all patients included in the study. The total amount of transplanted autologous adipose tissue was 20–200 ml.
Results. Over 24 months, 58.8 % of patients rated their appearance after autologous adipose tissue transplantation as «very good» and «excellent» and 29.4 % rated their appearance as «good». Only 11.8% of patients felt that their appearance was good at first, and then worsened.
Discussion. In order to obtain a predictable result, the surgeon must inject adipose tissue into living tissue under sterile conditions and refrain from external contact in order to prevent infection. Transplants with a high percentage of components, such as blood and local factors, reduce the ability to predict accurate body volume.
Conclusion. Have shown that the degree of satisfaction observed in patients after autologous adipose tissue grafting gives aesthetically acceptable results in terms of correction of deformities after liposuction. With the acceptance of aesthetic surgery in general and the increasing number of liposuction patients, it is clear that plastic surgeons in the future will face patients seeking secondary contouring surgery. Successful autologous adipose tissue transplantation is based on the appropriate technique, awareness of limitations and understanding of the patient's goals.

Objective. To conduct a comparative analysis of uni- and bilobar stenting in unresectable malignant biliary hilar obstruction.
Material and methods. In the Botkin hospital (Moscow) from 2015 to 2019 antegrade self-expanding stenting was performed in 61 patients with unresectable malignant hilar obstruction. The patients were divided into 2 groups: group 1 — 27 had unilobar stenting and group 2 — 34 bilobar stenting. Patient characteristics: average age group 1 — 67.4±4.8, group 2 — 71.2±5.2; gender (m/f) group 1 — 12/15, group 2 — 19/15; bismuth type (II / IIIa / IIIb) group 1 — 6/11/10, group 2 — 4/18/12; ECOG group 1 — 2.4 ± 0.5, group 2 — 2.6 ± 0.4 (homogeneous groups).
Results. Technical success: group 1 — 93.1%, group 2 — 82.9% (p = 0.293); clinical success: group 1 — 77.8%, group 2 — 88.2% (p = 0.147). The complication rate was slightly lower in the first group, 4 out of 27 (14.8%) versus 7 out of 34 in the second (20.6%) (p = 0.293). The frequency of stent dysfunctions in the first 3 months was 10 (35.7%) in group 1 and 7 (41.2%) in group 2 (p = 0.238). The stent functioning time was 241 days in group 1 and 319 days in group 2 (p = 0.325). Subgroup analysis revealed a significant difference (p = 0.019) in a more rapid decrease in bilirubin in the group of patients without cholangitis. The median survival was not statistically significant.
Conclusion. As a result of the study, it can be concluded that the results of uni- and bilibar stenting do not significantly differ in the dynamics of laboratory parameters, the number of complications, and the duration of stent functioning.

Objective: to reduce the number of early postoperative inflammatory complications and deaths in patients with colon cancer complicated by acute obstruction by individualizing indications for choosing the type of decompression stomas, their location, as well as improving existing methods.
Material and methods: The article presents the results of application in 259 patients with colon cancer complicated by acute obstruction of various decompression stomas. The main group included 183 patients in whom a new individualized approach and methods of treatment were used when choosing the type of stoma. The second, control group, included 76 patients who had unloading stomas placed without taking into account the localization of the tumor, anthropometric and topographic anatomical features, as well as the degree and type of obesity.
Results: as the results of the study showed, after the imposition of double-barreled unloading transversostomas through the mini-access significantly less often than with the imposition of ileostomas, inflammatory complications, lethal outcomes develop, less often the probability of refusal to perform them.
Conclusion: the choice of the type of ileostomy, as well as the transverse one, should be individualized taking into account the anthropometric, anatomical and topographic features of the abdominal wall and intestines, the degree of thickness of the anterior abdominal wall and the type of obesity, and using new methods and technologies developed in the clinic.

Objective: to evaluate the effectiveness of endosonography guided fine needle aspiration (EUS-FNA) of focal lesions of the pancreas. Assessment of the impact of age, gender, size of the lesion and its localization on informativity of the puncture.
Material and methods: the retrospective study included 244 patients between 2012 and 2020 who underwent EUS-FNA for pancreatic lesions. The factors influencing the information content were determined and their statistical processing was carried out.
Results: 454 morphological studies were performed in 244 patients. Of these, 211 are cytological, 149 are histological, and 94 are immunohistochemical (IHC). The frequency of informative conclusions was higher in the IHC group compared to cytological (p=1.611×10-6) and histological studies (p=3.617×10-5). The information content in the puncture of solid formations was 75.5%, cystic-solid — 80.4%, and cystic — 28.9%. (p=9.393×10-7). Informativity is significantly reduced when EUS signs of background pancreatitis are detected (p=0.0026).
Conclusion: EUS-FNA is an effective and safe method for obtaining material for morphological diagnostics. EUS-FNA of cystic formations is the least informative and is associated with the greatest cases of complications. Age, gender, size of the lesion, and its localization has no effect on informativity of the puncture. Background chronic pancreatitis significantly reduces the informativity of EUS-TAP. 

Purpose. To study the results of surgical treatment of patients with thyroid disorders using neuromonitoring, which allows to reduce the incidence of recurrent laryngeal nerve injuries during surgical interventions.
Materials and methods. The data of 198 patients who underwent surgery on the thyroid gland for benign thyroid disease were retrospectively analyzed. The mean age of the surgically operated patients was 48±17 y.o., including 38 (19.2%) men and 160 (80.8%) women. The patients were divided into two groups of 98 and 100 patients. The patients of the first group underwent surgical intervention using IOM, and the patients of the second group — without it.
Results. In the postoperative period of the first group, transient paralysis developed in 5 (5.1%) patients and permanent paralysis - in 1 (1.0%) patient. The duration of visualization and nerve isolation in the surgical site was 6.11±0.5 min. The total time of the surgery was 74.8±3.1 minutes. In the second group, transient paralysis developed in 10 (10%) patients and permanent paralysis developed in 3 (3%) patients in the postoperative period. The duration of visualization and nerve isolation in the surgical site was 12.7±1.9 min. The total time of the surgery was 86.11±4.0 minutes. The differences between the groups in incidence rate of transient and permanent paralysis were statistically significant (p = 0.01; p = 0.001).
Conclusion. Intraoperative monitoring of the recurrent laryngeal nerve during various surgical interventions on the thyroid gland is a safe and highly effective method allowing reduce the incidence of complications and surgery duration. 

Objective: in this work, devoted to one of the topical issues of modern surgery — bariatric sleeve gastrectomy surgery in connection with morbid obesity, the main goal was to identify the causes and establish ways to prevent the development of fibrous tissue in the liver after surgery.
Material and methods: the process of free lipid peroxidation in liver tissue after sleeve gastrectomy was experimentally studied. The objects of the experimental studies were divided into 7 groups — 5 heads each, 35 rabbits from the genus Chinchilla. The weight of the rabbits selected for the experiments was 3–4.5 kg. The data obtained in the course of the carried out experiments were statistically analyzed by nonparametric methods.
Results: as a result of the experimental studies, it was found that after bariatric sleeve gastrectomy surgery, oxidative stress occurs in the liver tissue. Moreover, in this case, the process of free radicalization of lipids lasts more than six months.
Conclusion: based on the comparative analysis of the obtained experimental results, it was shown that the oxidative stress detected in appropriate cases plays an important role in the pathogenesis of the development of fibrous tissue in the liver. Despite the observation of a gradual decrease trend starting from the 30th day after the operation, the stress that has arisen continues for six months. It was found that intravenous administration of a solution of reditox significantly enhances the antioxidant defense system, significantly reducing the concentration of oxidative stress markers, hydrogen peroxide, diene conjugates, and malondaldehyde.

Objective: the aim of this work was to study the results of treatment of patients with severe sepsis based on the inclusion of modern methods of extracorporeal detoxification in the process of complex intensive care.
Material and methods: a randomized controlled study was conducted taking into account the data of the clinical and diagnostic characteristics of two groups of patients with sepsis:
Study group (n = 30) — patients who underwent hemodiafiltration at the earliest possible time after the development of septic shock with the inclusion of a highly selective cytokine adsorber in the circuit for 6 hours.
The control group (n = 30) — patients who underwent hemodiafiltration with bicarbonate buffer replacement solution for 6 hours under the conditions of complex intensive therapy for septic shock.
A statistically significant decrease in the actual 28-day mortality rate in the study group compared to the control group of patients served as a direct criterion of effectiveness.
Results: The 28-day mortality rate in the main group was 20%, which indicates better results compared to the control group, where the mortality rate was 50%.
Conclusion: the inclusion of a highly selective cytokine adsorber in the complex therapy of severe sepsis has a positive effect on the course and prognosis of the disease.

Background. According to the literature, the development of GERD and migration of the sleeve to the posterior mediastinum after gastric sleeve surgery (GSS) and SADI-S surgery ranges from 7 to 30% [13]. When GERD is diagnosed in patients before surgery, there are no clear instructions on surgical tactics [8]. Several surgical options are suggested, including surgery conversion to RYGB or MGB, as well as conservative treatment with proton pump inhibitors, H2-blockers, prokinetics, and deoxycholic acid in the postoperative period, which is sometimes unsuccessful [15]. We consider the solution of this problem an urgent task of modern bariatric surgery.
Objective. Improving the quality of life of patients developing GERD after GSS and SADI-S, as well as reducing the number of complications in the postoperative period (reflux esophagitis, Barrett's esophagus).
Material and methods. 379 GSS and 173 SADI-S procedures for morbid obesity were performed in the surgical department of RCH in 2016–2019. 52 patients developed full-blown GERD at various times after the surgery, and it required surgical correction in 6 of them.
Revision involved posterior cruroraphy, strengthening of the esophageal hiatus with a mesh implant and the antireflux cuff formation with the round ligament of the liver.
Results. No relapses of reflux esophagitis were registered within the postoperative period from three months to 1.5 years. After the revision antireflux surgeries, all symptoms of the disease regressed, and the quality of life of patients improved.

Purpose. The purpose of this work was a retrospective study of open literature sources and data from our own experimental studies to determine the pathomorphological features of a gunshot injury in persons whose profession is associated with a high risk to life, resulting from the hitting of low-speed weapons in a «soft» body armor.
Materials and methods. The study used a systematic review of the literature in the public domain and its own materials. Analysis of the obtained reporting data characterizing the obtained trauma as zabroniya is carried out with determination of its severity and prognosis of the current.
Results. Behind armor blunt trauma (BABT) in the «soft» body armor is characterized not only by injuries to soft tissues and internal organs in the projection of the wound projectile, but also by the occurrence of penetrating injuries to the chest and abdomen even when the protective structure is not broken. The volume of gunshot damage during the through penetration of the «soft» body armor can increase due to the loss of stability of the bullet, the introduction of fragments of bullets and vest into the wound canal, as well as the formation of a bruising zone around the wound canal. Life-threatening consequences of distant damage to the organs of the chest and abdomen, which can manifest delayed.\
Conclusion. A gunshot injury through concealed body armor is a very urgent problem of both military and civilian medicine, its pathogenesis, diagnosis and treatment have a number of distinctive features. The emergency system for victims of peacetime gunshot injury faces insufficient awareness and training of ambulance physicians, making it necessary to develop a standard of care and patient management tactics with BABT. Each victim with a gunshot injury in body armor should be subjected to a thorough examination in order to identify the nature and volume of injuries to the internal organs of the chest and abdomen, respecting the rules for carefully documenting all the facts of the wound.

The persisting high rate of postoperative mortality in cases of diffuse peritonitis with sepsis and septic shock demonstrate not only the complexity of the problem, the difficulty of its radical solution for many decades despite the modern achievements of intensive care and surgery and necessity for further search for various methods and approaches in treatment of this category of patients.
The clinical effectiveness of the use of relaparotomy «on demand» and «on program» for diffuse peritonitis, remains not well defined, requiring clinical studies with high level of evidence. There are also an extremely small number of studies comparing the effectiveness of vacuum-assisted laparostomy (VAC-laparostomy) and conventional laparostomy.

Mucocele of the appendix is a rare pathology without pathognomonic symptoms, which is more common as an incidental finding. The frequency of occurrence, according to the world literature, does not exceed 0.2–0.3 %, and in women the frequency of occurrence is 7 times more frequent. Many authors regard this type of pathology as a precancerous disease. Intussusception is a type of intestinal obstruction in which one part of the intestine is introduced into the lumen of another, causing obstruction. The frequency of occurrence of intussusception of the large intestine in adults, according to the literature, is no more than 5 %. This clinical example demonstrates a case of detection of intussusception of the large intestine, which caused acute intestinal obstruction in combination with mucocele of the appendix. A 45-year-old female patient was admitted to a hospital with suspected intestinal bleeding, an additional examination revealed intestinal obstruction, the patient was operated on, during surgery, a mucocele of the vermiform appendix was found in combination with invagination intestinal obstruction caused by a tumor of the colon. The course of the postoperative period was smooth, the wounds healed by primary intention. After the performed surgical treatment and receiving a histological report, the patient was discharged under the supervision of an oncologist on an outpatient basis.

Introduction: endometrial cancer has a direct correlation with obesity. Risks of this type of cancer increase with the body weight gain and expected response to treatment becomes less favorable. Significant and persistent weight loss of hysterocarcinoma female with morbid obesity has a positive impact on oncological results, further quality of life, state of comorbidity. Laparoscopic hysterectomy is a priority treatment of early endometrial cancer. Bariatric surgery is considered to be the most effective and radical method of morbid obesity correction.
Clinical case: the cases of bariatric surgery to influence positively the results of carcinoma treatment outcome before and after the main stage have increased recently. An experience of concurrent simultaneous radical surgery of сancer and morbid obesity correction is isolated worldwide nowadays. We would like to present the clinical case of concurrent laparoscopic sleeve gastrectomy and laparoscopic hysterectomy of a 45-year-old female patient with endometrial carcinoma stage IA, morbid obesity and 2 type diabetes mellitus. The short-term results of this case are 21,2% overweight loss within 2 months, sustained remission of diabetes mellitus, clinical group III.
Discussion: the described case is theoretically justified and has, although few, practical prototypes that appear in publications of recent years after successful clinical application.
Conclusion: the current small world experience of such cases requires further accumulation and development of practical aspects and a more detailed study of this topic.

Introduction: Paragangliomas are rare neuroendocrine neoplasms with a frequency of 0.001–0.01% in the general population, which arise from the adrenal medulla and extrarenal autonomic paraganglia, respectively. Paraganliomas of the heart are extremely rare primary neuroendocrine tumors of the heart, accounting for less than 1% of all cardiac neoplasms. Their location is clinically important as they can interfere with heart function. For large paragangliomas of the heart with myocardial invasion, the need for heart reconstruction or transplantation may potentially arise.
Materials and methods: the presented experience, due to clinical multifactoriality, included several options for staged treatment.
Discussion: in our case, taking into account the secretion of catecholamines, sick sinus syndrome, a high risk of bleeding, and tumor fragmentation, the first stage was to achieve the regression of the tumor by means of embolization with afferent spirals feeding the heart tumor. However, due to several sources of blood supply to the formation, this method of treatment did not lead to the desired effect. In this regard, the tactics of open surgical intervention was chosen to remove the formation with the reconstruction of the heart chambers. According to the data of postoperative biopsy, data on paraganglioma were obtained.
Conclusion: This experience shows the importance of a multidisciplinary and personalized approach to treating patients in a multidisciplinary hospital.

Introduction: paragangliomas are rare neuroendocrine neoplasms with a frequency of 0.001–0.01% in population, which arise from the adrenal medulla and extrarenal autonomic paraganglia, respectively. Paragangliomas of the heart are extremely rare primary neuroendocrine tumors of the heart, accounting for less than 1% of all cardiac neoplasms. Their location is clinically important as they can interfere with heart function. For large paragangliomas of the heart with myocardial invasion, the need for heart reconstruction or transplantation may potentially arise.
Discussion: in our case, taking into account the secretion of catecholamines, sick sinus syndrome, a high risk of bleeding, and tumor fragmentation, the first stage was to achieve the regression of the tumor by means of embolization of heart tumor suppliying afferent with coils. However, due to several sources of blood supply of newgrowth, this method of treatment did not lead to the desired effect. In this regard, the tactics of open surgical intervention was chosen to remove the newgrowth with the reconstruction of heart chambers. According to the data of postoperative biopsy, removed tumor was paraganglioma.
Conclusion: this experience shows the importance of a multidisciplinary and personalized approach in treatment of patients in a multidisciplinary hospital.

Introduction: more than 20 million hernia surgeries are performed worldwide each year. Abdominal hernias are detected in 7% of the total population, mainly in people of working age. Hernia of the anterior abdominal wall is one of the most common surgical problems affecting a significant proportion of patients around the world. The main causes of hernias are a violation of the level collagen ratio in the scar tissue and technical errors in the technique of closing laparotomic wounds, which leads to the formation of postoperative hernias.
Clinical case: the article presents a clinical case of treatment of a patient with postoperative ventral hernia and «domain loss», complicated by infection of the mesh prosthesis in the postoperative period. Difficulties in choosing the optimal treatment tactics for this category of patients, such as making a decision to remove the mesh prosthesis or to continue conservative methods of treatment, have been noted.
Conclusion: conservative methods inevitably increase the duration of treatment and hospital stay, which adversely affects not only the physical condition of the patient, but also the psychological element of long-term therapy. The chosen strategy in this clinical case was compared with previously published materials of other authors. Treatment of this category of patients should be carried out in hospitals of a wide profile, which have in their arsenal all the necessary diagnostic equipment, the possibility of operative consultation of any related specialist, if necessary, as well as the possibility of timely change of antibacterial drugs, if required by the clinical situation.

The article highlights domestic priorities in developing a method of cadaveric blood transfusion. On March 23, 1930 S.S. Yudin together with his assistants made the first blood transfusion taken from the deceased, which is considered the birthday of this method. It is noted that subsequent clinical observations were no less difficult than this first case of transfusion of postmortem blood, but this did not stop S.S. Yudin, and with surprising persistence and enthusiasm, he continued to work on the study of this method. Among his assistants in the first place marked R.G. Sakayan, M.G. Skundin, S.I. Barenboim and A.V. Rusakov, who have put a lot of work into this difficult task. After the end of the great Patriotic war, S.S. Yudin decided to generalize his vast experience in transfusion of postmortem blood and in 1950 began working on a large monograph, in which he wanted to present «twenty Years of experience in procurement, storage and transfusion of postmortem blood». The author emphasizes that more than 10,000 transfusions of postmortem blood produced at the Sklifosovsky Institute allow him to draw quite definite conclusions and give the reader a number of important practical tips on the use of postmortem blood. It is shown that the idea of transfusion of postmortem blood marked the beginning of a new era in surgery — the use of tissue taken from corpses for transplants.