Purpose of the work: to study and evaluate the results of conservative and surgical methods of treatment of ulcerative colitis in a hospital setting.
Material and methods: we carried out a retrospective analysis of the results of conservative and surgical methods of treatment of patients with ulcerative colitis who were hospitalized in the colopractology department of the ASMI clinic for the period from 2009 to 2020. All patients were divided by us into two groups. The first group included patients who received conservative treatment (n = 822), and the second group included patients (n = 165), who underwent surgery.
Results: an evaluative retrospective analysis of conservative and surgical methods for the treatment of ulcerative colitis in a hospital setting shows that in 46.6 % of cases, the peak of this incidence occurs in the age group from 20 to 40 years. Conservative therapy in this study accounted for 83.3 % of cases, and surgical interventions were used in 16.7 % of cases. In addition, for more than 10 years, the existing ulcerative colitis is often malignant in the oncological process. And this was confirmed by analyzes in 8 of our patients, who had a history of ulcerative colitis for about 10 years or more.

Objective: To exchange clinical experience between surgeons, namely, private methods of physical examination of adult patients with acute appendicitis.
Material and methods. Between January 2017 and December 2020, the sample included 300 patients aged 18–55 years (average age was 36.4±3.2 years), without gender. The study included two stages: pre-hospital (assessment of symptoms by paramedics and doctors of linear teams of ambulances, doctors of primary (polyclinic) level) and hospital (assessment of symptoms by surgeons of the hospital's emergency Department with subsequent comparative verification by laboratory and instrumental, including intraoperative diagnostics). In total, the study included 20 paramedics and 5 doctors of linear emergency medical teams and 5 doctors of polyclinics in Volgograd and 15 surgeons of emergency departments.
Results. During the performed study was to obtain results that indicate sufficient validity of the studied prehospital appendicular symptoms, which allows to conclude the following: the symptom is R. V. Soft was accurate in 87%, and symptom I. Krayushkina in 86% of cases of destructive forms of acute appendicitis.
Conclusion. These appendicular symptoms can be recommended for use in routine clinical practice, both at the prehospital and hospital stages of diagnosis of acute appendicitis in adults.

Introduction. The results of treatment of inguinal hernias are unsatisfactory. 13% of all hernia repairs in the world are performed due to recurrent inguinal hernia (RIH). Most often, relapses occur after autoplastic surgery (29–30%). Modern alloplastic methods of hernia repair, open or closed, are not devoid of relapses. Even after total preperitoneal alloplasty, they reach 10–15%. In addition, the disadvantage of these operations is their high cost.
Materials and methods. Retrospective analysis of case histories of 99 patients with RIH operated on in 1999–2020 in whom were used autoplasty methods with autodermoplasty was performed: 1. Preperitoneal autodermoplasty of the posterior wall of inguinal canal with autoplasty of the anterior wall; 2. Posterior wall autoplasty of the inguinal canal using a relaxing incision of the anterior wall of the sheath of rectus muscle with autodermoplasty.
Results. There were 6 (6,1%) complications in the early postoperative period and 7 (7%) cases of recurrences in the long term.
Conclusion. Preperitoneal autodermoplasty with autoplasty of the anterior wall of the inguinal canal insufficiently protects the inguinal region from the recurrence: 5 (12,5%) hernia recurrences were revealed among the operated 40 patients in the long term. Autoplasty of the posterior wall of inguinal canal with relaxing incisions of the aponeurosis of the anterior leaf of sheath of rectus muscle with autodermoplasty according to proposed methods was the most reliable. No recurrences were found among the 40 operated patients (follow-up of 12 years).

Objective. Currently, Roux-en-Y reconstruction is a standard surgical technique, and in some cases — the method of choice, for distal resection of the stomach and gastrectomy, for repeated operations on the upper section of the digestive tube and the formation of bilio-digestive anastomoses, for various options for resection of the pancreas, in practice metabolic / bariatric surgery. The aim of this study was to demonstrate the possibilities of using Roux-en-Y reconstruction in surgery of malignant neoplasms of the gastropancreatoduodenal region.
Material and methods. The authors presented the experience of using the Roux-en-Y principle in oncosurgery of the gastropancreatoduodenal zone during distal gastric resections, total gastrectomies and gastropancreatoduodenal resections. A comparative analysis of the immediate and long-term functional results of 267 surgical interventions with Ru-style reconstruction and 79 operations performed with other reconstruction options was carried out.
Results. A fundamentally better patient tolerance of Roux-en-Y reconstruction was established according to the criteria of the course of the immediate postoperative period (intraoperative complications 12.8% vs 44.3%, the number of relaparotomies 3.4 vs 20.4%, postoperative mortality 4.5 vs 11, 3%), as well as the best functional results of Roux-en-Y reconstruction in relation to the occurrence of impaired gastric evacuation, gastric and esophageal reflux in the near and long term.
Conclusion. The experience and results of applying the Roux-en-Y concept, demonstrated in this study, are another confirmation of the unique properties of this reconstruction option - pathogenetic validity, technical reproducibility, predictability of immediate and long-term results - and the related demand for Roux-en-Y reconstruction in abdominal surgery.

Background. The steady development of modern minimally invasive technologies makes it possible to use laparoscopic and robotic methods of treatment for liver echinococcosis.
Material and methods: Since 2018, in the surgical clinic of the Botkin Hospital, laparoscopic and robotic interventions in the volume of pericystectomy and liver resection have been used for liver echinococcosis. During the period from February 2018 to November 2020, 8 minimally invasive interventions were performed: 5 laparoscopic and 3 robotic. The study assessed postoperative complications according to the Clavien–Dindo classification, specific complications according to ISGLS, and relapses during the first year after surgery.
Results. Comparing immediate and long-term results, no differences were found in the duration of the operation, the frequency of transfusion of blood components, the incidence of severe postoperative complications (class III and more according to Clavien–Dindo), the presence of specific complications according to the ISGLS classification. Minimally invasive operations were accompanied by statistically significantly less blood loss compared to open ones: 54 (0–270) ml and 157 (70–560) ml (p <0.001), respectively, as well as shorter inpatient treatment: 4 (1–6) and 12 (7–35) days (p <0.001).
Conclusion. Thus, laparoscopic and robotic technologies are gradually finding their place in the attraction of hydatide liver lesions. These modifications of traditional surgical procedures reduce the number and severity of postoperative complications and improve treatment results.

Introduction. The aim of this work was to improve the method for assessing the severity condition and the probability of death in patients with burn disease based on the study of spectral parameters heart rate variability, their dependence on the severity burns and correlations with the outcome burn disease.
Materials and methods: 84 patients (57 men and 27 women) aged 21–65 years (mean 44.2±2.8) were examined. The inclusion criteria for the study were: the presence of superficial burns of more than 15% or deep burns of more than 10% of the body area, or a combination of deep and superficial burns with a total area of more than 15% of the body area.
Results: The study revealed that in case of a burn injury, there is a suppression of the wave structure of the heart rate and indicators of the total power of the spectrum, which are recorded already in the first hours after the burn. The degree of suppression of spectral indicators of heart rate variability depended on the severity of the burn. A correlation was revealed between the severity index and the values of the spectrum power in the low and high frequency ranges and the total power of the heart rate variability spectrum.
Conclusion: Heart rate variability has a prognostic value, since a correlation was found between an unfavorable outcome and indicators of heart rate variability recorded upon admission to the hospital. A mathematical model has been developed for assessing the severity of the burned person's condition and the likelihood of death.

Objective: Improvement of the results of treatment of patients operated on for perforated duodenal ulcer (PDU) with the use of the Enhanced Recovery Protocol (ERP).
Material and methods. The results of surgical treatment of 102 patients with PDU in the period 2015–2019 were analyzed. A monocenter prospective randomized study was performed at the clinical base of the Department of surgery and endoscopy of the Pirogov Russian National Research Medical University. The operated patients were divided into 2 groups: the main group (fast-track group (FT-group), with ERP) and the control group (CG, standard perioperative management). The severity of postoperative complications was assessed according to the Clavien–Dindo scale.
Results. In the FT-group, the duration of the operation was 78.96±4.51 minutes. In the FT-group, 3 postoperative complications were identified. The duration of hospitalization is 3.85±0.14 days. In CG, the duration of the operation was 114.32±8.73 minutes. 10 postoperative complications were identified in the CG. The duration of hospitalization is 6.84±0.29 days. There were no deaths or repeated hospitalizations in both groups.
Conclusion. The use of ERP can improve the immediate results of surgical treatment of patients with PDU and reduce the length of hospital stay.

Introduction. This article describes the clinic and diagnosis of retrosternal goiter and methods of surgical treatment.
Materials and methods. The aim of this study was to identify preoperative predictors of sternotomy in the treatment of retrosternal goiter. In the period from 2012 to 2019 in clinic were hospitalised 820 patients. Of these, 48 (5.8%) had a retrosternal goiter and were included in the study. The age of patients varied from 48 to 75 years, the average age was 49.8 years. There were 8 men (16.7%) and 40 women (83.3%). All retrosternal goiter were surgically treated with 44 (91.7%) cervical accesses and 4 (8.3%) sternotomy. The essence of the technique is to ensure maximum mobility of the removed share with the chest component when mobilizing it from top to bottom. The diagnosis was made by chest x-ray, thyroid ultrasound, CT and MRI, as well as thyroid scintography. All patients were given clinical, biochemical analyses and coagulogram.
Results. All operations were successful, without serious postoperative complications. Unknown postoperative complications of transient hypocalcemia and transient paralysis of the recurrent laryngeal nerve occurred in 6 (12.5%) and 2 (4.2%). An indication for the average stereotomy was the extension of the goitre below the aortic arch, a large thyroid tissue, extending to the bifurcation of the trachea and ectopic thyroid tissue in the mediastinum.
Conclusions. The retrosternal goiter can be removed through a neck incision, but in rare cases a median sternotomy may be required.

Introduction. The aim of the study was to determine the laparoscopic abdominal integral index for the evaluation of surgery conditions for the selected one or two-stage surgical treatment of super-obesity.
Methods. The author has applied the approach of the method for calculating the abdominal integral index to assess the operating conditions in working into the laparoscopic cavity on the basis on sum of the main measurements.
Results. It is proposed to distinguish five levels of complexity of operations with different intervals of abdominal integral index values with an assessment of the operating conditions from «optimal» to «extremely bad». The use of the abdominal integral index in two patients with the same height and the same body weight. In this case, a different result of abdominal integral index was revealed. In accordance with the index equal to 3.99 points, the assessment corresponding to the criterion «acceptable operating conditions» was established, and the other, in the case of a value of 2.9, the assessment of «poor operating conditions» was established.
Conclusions. The abdominal integral index for evaluating the operating conditions during super-obesity, based on linear measurements, provides a standardized, objective assessment and allows you to choose between one or two-stage surgical treatment.

Relevance. The aspect of personalization in the use of the EVLO method is not sufficiently developed, which indicates the legality of further research in this area of surgery.
The aim of the study to assess the quality of surgical care for patients with chronic venous insufficiency and identify the factors that determine it.
Materials and methods. Studies in 428 patients with UBPC in outpatient settings. All patients are women. Endovazal laser obliteration (EVLO) has been performed in the traditional way. The design of the study included the use of a number of methods: clinical examination, special methods, assessment of patient preparedness for intervention, assessment of quality of life. The effectiveness of surgery was determined by the criteria set out in the clinical recommendations. Statistical analysis of the results was carried out with the help of modern computer technologies based on the statistical software package Statistica 6.
Results. It has been established that patients who are admitted to surgical treatment are under prepared. The information, clinical and psychological components of the patient's preparedness for surgery have a level of 65.0-89.0% of the due and affect the outcome of the intervention. Personalized approach in surgical treatment by EVLO contributes to improving the quality of life and reducing pathological reflux by 9.3-8.0%.
Conclusion. The persolized approach to the rapid treatment of patients with UBNC by the EVLO method is based on the assessment of their preparedness for intervention and the use of technological maps and check-lists to monitor the implementation of necessary measures. This provides rapid clinical recovery of patients, improving their quality of life, satisfaction with results, good hemodynamic and cosmetic effects.

Purpose of study. Provide Systematized data on the blood supply of the stomach and duodenum, relevant for endovascular methods of homeostasis.
Material and methods. 117 multispiral computed tomograms with bolus contrast enhancement of the arterial phase.
Results. The normal structure of the celiac trunk is established in 88.89% of cases, hepatosplenic trunk identified in 0.85% of cases, hepatogastric trunk — in 0.85% of cases, gastrosplenic trunk — in 1.71% of cases, hepato mesenteric trunk — in 5.13% of cases, celiac colon trunk — in 1.71% of cases. Stomach blood supply in 54.70% of cases was carried out mainly by the right gastric artery and the right gastroepiploic artery, in 15.34% of cases by the left gastric artery and the left gastroepiploic artery. Anastomosis between the right gastric artery and the left gastric artery, as a single vessel had a 55.55% of cases. The common hepatic artery is the source of right gastric artery in 67.52% of cases. Normal structure of hepatoduodenale arteries established in 82.2% of cases. In 91.45% of cases the celiac trunk and superior mesenteric artery combined along the duodenum by anastomosis.
Conclusion. When the source of bleeding is localized in the lesser curvature or in the antrum embolisation of the left gastric artery is advisable. When the source of bleeding is localized in the greater curvature, selective embolisation of the right gastroepiploic artery is advisable. When the source is localized in the pylorus of the stomach or in the duodenum bulb it’s necessary to embolize sequentially ostia superior pancreaticoduodenal artery and gastroduodenal artery. When the source of bleeding is localized distal to the duodenum bulb required selective embolisation superior anterior pancreaticoduodenal artery, if hemostasis is ineffective, it is necessary to embolize the ostia of the inferior anterior pancreatic-duodenal artery.

Introduction. Wound infection, including postoperative infection, has been and remains one of the most pressing problems in surgery. Therefore, the most urgent task for all areas of surgery is to develop rational schemes for the prevention and treatment of purulent-inflammatory diseases.
The purpose of the study. To study the effectiveness of the use of a broad-spectrum antiseptic «MestaМidin-sens» for the treatment of purulent-septic postoperative complications and to compare the results with traditional, generally accepted methods of treatment.
Materials and methods. The basis of this work was the experience of treating 32 patients with purulent-necrotic process over the past year (2020).
Results and their discussions. In patients who were treated with the antiseptic «MestaМidin-sens», in a shorter time, it was possible to stop the acute purulent process, perform step-by-step surgical interventions.
Conclusions. Antiseptics should be carried out taking into account a number of factors, and the antiseptics used for this purpose should have a number of additional properties. The use of the antiseptic «MestaМidin-sens» reduces the bed-day stay in the hospital, which is undoubtedly economically feasible.

Introduction. Diabetes mellitus is a serious disease, firmly occupying the first place in disability and the third place in mortality in the world. One of the most dangerous complications of diabetes mellitus is diabetic foot syndrome, since this complication is the main "culprit" of amputation and disability of patients. The absence of pain sensitivity in patients with neuropathy complicates the treatment of plantar ulcers. Widely and successfully applied modern methods of treatment will not lead to the healing of the ulcer defect without unloading the foot. To prevent the formation and recurrence of plantar neuropathic ulcers, it is optimal to make individual orthopedic shoes.
Clinical case. Patient R., 58 years old, complained of an increase in temperature to 38.40 C, redness and swelling of the left foot and lower leg, the presence of calluses with ulceration on 1 finger of the left foot, redness, swelling and ulcerative defect of 2 fingers of the left foot. Without receiving medical care in the polyclinic and in the diabetic foot center, the patient turned to us. At the first examination, the nail phalanx was removed with a pitted articular surface of 2 fingers of the left foot. Further treatment for three weeks led to the healing of ulcerative defects. However, after stopping wearing the orthosis and prolonged load on the foot, the patient suffered a hemorrhage in the callus of the 1st finger with subsequent infection. The refusal to wear the orthosis delayed the treatment process for three months. Only after the patient began to use unloading shoes, the ulcer was healed.
Conclusion. This clinical observation demonstrates problems in the treatment of diabetic foot ulcers. The wrong tactics of the outpatient doctors almost led to the loss of a part of the patient's limb. The inadequate attitude of the patient to his disease has complicated and prolonged the treatment of the ulcer defect. Only joint efforts will reduce disability and mortality in such a complication as diabetic foot.

May-Thurner syndrome (CMT) is a disease characterized by compression of the left common iliac vein of the small pelvis by the right iliac artery. Clinically manifested by persistent pelvic pain as well as pain in the left lower extremity. One of the most common symptoms of this syndrome which should be considered is an edema of the left lower limb. The peculiarity of this disease is that the clinical picture is not always specific and is often masked by venous insufficiency of the lower extremities. Therefore, it is important to determine the main cause of the disease and conduct the entire complex of the necessary additional examination. Traditional open surgical interventions in this direction are practically not used today due to their trauma and long rehabilitation period, giving way to a safer and more effective method of treating the compression of the iliac veins - endovascular venous stenting. The first successful stenting of the iliac vein was performed back in 1995. Thus, the tactics of treating May-Turner syndrome have evolved and today, endovascular treatment is preferred as the main method of treatment. Thanks to venous angioplasty and stenting, it is possible to achieve the required clinical result in a low-traumatic and fast manner.

Aim. The purpose of describing this clinical observation was to demonstrate the clinical and instrumental picture and tactics of reconstructive surgery in the development of combined ischemia of the large intestine and lower extremities due to thrombotic occlusion of the infrarenal aortic aneurysm.
Case. Patient R., 72 years old, was admitted to the clinic on 09/11/2020. with complaints of numbness in the toes of both feet, pain in the muscles of both thighs and legs, discomfort and bloating in the left abdomen, delayed bowel movements. After an additional examination in the hospital, the following clinical diagnosis was formulated: Atherosclerosis of the aorta and its branches. Thrombosis of the infrarenal aortic aneurysm. Thrombosis of the iliac arteries. Critical ischemia of the lower extremities. Essential hypertension of the II degree, erosive gastritis, ischemic colitis. 09/13/2020 the patient underwent surgery: Thrombectomy from the infrarenal aorta, aorto-femoral bifurcation prosthetics with a synthetic prosthesis with silver ions with replantation of the inferior mesenteric artery into the main branch of the prosthesis from a mini-access. Smooth postoperative course.
Conclusion. In the given clinical observation, long-term stenosing atherosclerosis of the aorta and iliac arteries in combination with essential hypertension led to the formation of an aneurysm of the abdominal aorta and was complicated by thrombosis. This clinical picture required a complete revascularization of all affected arterial basins: the left half of the large intestine, lower extremities. Carrying out a large volume of surgery using minimally invasive technology contributes to the restoration of the function of the intestines and lower extremities in the shortest possible time, as well as rapid physical and social rehabilitation of the patient.

Introduction. One of the most complex and rapidly developing areas in cardiovascular surgery is aortic surgery. In recent years, surgery for combined aortic pathology, as well as reconstructive surgery of the aortic root and aortic valve, has been actively developing. Today, with aneurysm of the ascending aorta with aortic insufficiency and the absence of morphological changes in the aortic valve flaps, they try to resort to various options of valve-preserving operations. The progress achieved in endovascular treatment of aortic pathology has reduced operational mortality and improved the long-term results of treatment of abdominal aortic aneurysms.
Clinical characteristics of the patient. In the described clinical case, taking into account the general severity of the patient's condition and the high risks of simultaneous surgery, the tactics of two-stage surgical treatment were chosen. The first stage is prosthetics of the ascending aorta with the preservation of the native valve, the second stage is endovascular treatment of the infrarenal aorta.
Conclusion. This work demonstrates the successful clinical experience of a multidisciplinary approach to the two-stage treatment of a patient with aneurysm of the root and ascending aorta with aortic valve insufficiency and aneurysm of the infrarenal aorta.

The development of surgery at the beginning of the XX century is analyzed. The main achievements of the «Golden age» surgery were noted. Scientific priorities of the XV Congress of Russian surgeons are presented and the main program issues are highlighted. One of the most important topics discussed at the Congress was the question of pathogenesis and treatment of spontaneous gangrene of the lower extremities (obliterating endarteritis). It is noted that the attention of surgeons and therapists was attracted by the reports made at the XV Congress of surgeons by Professor V.N. Shevkunenko and his staff on the program issue of anatomy, pathology and vascular system clinic. The statements put forward in these reports about the presence of main and loose types of vascular branching made us think whether the differences in the resistance of different organisms to diseases are not related to these differences in the structure of the vascular network. It was found that the innervation of the vascular system differs in an individual feature, since the place of approach to the vessel wall of the sources of nerve supply and the territory of distribution of vascular nerves in different individuals are not the same. Much attention was paid to the variability of organs and systems of the human body, associated with the influence of the external environment, labor processes. At the same time, it was pointed out that the doctrine of variability can be very fruitful if we study not only the differences in the structure of organs and systems, but also the features of functions that are characterized by differences in the structure of these formations. In addition to the program questions, there were reports on intestinal inversion, gallstone disease, liver abscesses, treatment of purulent wounds without tampons, as well as urology issues that aroused the lively interest of the participants of the Congress.