Objective. The main factors of reducing the quality of life of patients after surgical treatment of inguinal hernias are recurrence of the disease (R) and the development of chronic pain syndrome (CPS).

Material and methods. The results of surgical treatment of 1897 patients with inguinal hernias who underwent laparoscopic hernioplasty using the TARR method are analyzed. The aim of the study was to identify the causes of CPS development and recurrence of inguinal hernia, depending on the type and size of the mesh, as well as the technical features of the operation. In 842 patients, a self - fixing ProGrip ™ mesh was used, in 1054 patients - a light composite VYPRO II mesh.

Results. In group 1, recurrence of inguinal hernia was noted in 1 patient (0.12%) with a small size of mesh (less than 120 cm2), in group 2 (control) - in 7 (0.66%), including when using relatively large mesh (more than 140 cm2). The cause of recurrence is the migration of the mesh due to its insufficient size or fixation. CPS was observed in 1 patient of the main group, whereas in the control group there were 13 such patients. The reasons are directly related to the method of fixing the mesh: direct contact of the metal bracket with a nerve branch or the development of a scar in the area of the suture or fixing element.

Conclusions. A self-fixing implant of sufficient size (at least 10x15 cm), which ensures the" sticking " of the mesh over the entire surface, reliably protects the patient from both the development of CBC and the recurrence of the disease. An indirect cause of relapse may also be an increase in the patient's body weight after surgery.

Objective. The disadvantages of sternotomic access to the heart include high traumatism, violation of the integrity of the chest frame The purpose of the study: to improve the effectiveness of treatment of cardiac surgery patients using minimally invasive technologies.

Research objectives:

1. To establish the effectiveness of the use of minimally invasive technologies in the treatment of cardiac pathology.
2. Reduce the risk of local and cardiopulmonary complications using minimally invasive technologies.

Materials and methods. During the period from 2016 to 2020, 1989 surgical treatments were performed in the CWC of the Federal Agricultural Research Center of Krasnoyarsk. Of these, 469 (23,4 %) operations were performed in patients with ischemic heart disease (CHD), 133 (6,6 %) operations were performed in patients with acquired mitral valve heart disease (PPS MK) and 245 (12 %) operations were performed in patients with acquired aortic valve disease (PPS AK). Also, during the five-year period, 364 (18 %) patients with valvular pathology in combination with atrial fibrillation were operated on. The group of patients who underwent a complete sternotomy included 140 patients, and the group in which the operation was performed through mini-access included 90 patients.

The results. On the part of the postoperative wound with a complete median sternotomy, five complications were observed in the form of a superficial and deep wound infection. While with minimally invasive access, such complications were not observed. The number of respiratory and heart failure, ONMC, AF in the postoperative period was significantly lower with mini-access. Bleeding in the postoperative period occurred in 5 patients with traditional access and in 2 patients with mini-access.

Conclusion. When using mini-access, we have an extremely low percentage of complications 19 versus 51, which certainly indicates that the use of minimally invasive approaches is a safe and effective way to improve the quality of treatment of patients, and also significantly reduces the risk of cardiopulmonary complications and complications from postoperative wounds.

Background. At present, the issue of choosing the type of biliary stent in obstructions of the terminal part of the common bile duct of malignant origin has been studied quite well, however, the issue of choosing a stent in case of dysfunctions of previously installed stents has practically not been studied.

Study purpose. The aim of the study was to compare mono- and parallel bistenting with plastic stents in case of dysfunction of an uncoated self-expanding stent placed for the purpose of decompression in case of obstruction of the terminal part of the common bile duct of malignant origin.

Study material and methods. The main group included 30 patients who received 2 parallel stent-to-stent stents during restentation, the control group consisted of 52 patients with 1 stent-to-stent plastic stent installed during restentation.

Outcomes: The advantage of the main group in comparison with the control group was statistically significant in terms of the rate of decrease in postoperative leukocytosis, direct bilirubin and common bile duct diameter. No statistically significant advantage of the control group in comparison with the main group was found for any of the studied parameters.

Conclusions. Preliminary conclusions can be drawn about the advantage of using the parallel bistening method with plastic stents compared to monostenting in the treatment of obstructive jaundice with dysfunction of a previously installed uncoated self-expanding metal stent.

Purpose. The purpose of this work was the experimental assessment of the pathophysiological features of the course of traumatic shock under conditions of extreme ambient temperatures.

Materials and methods. The experiment was carried out on 24 large animals (pigs) weighing 45-50 kg. The research was carried out in accordance with the directive 2010/63 / EU of the European Parliament and of the Council of the European Union on the protection of animals used for scientific purposes, 2012.

Results. Disorders of the acid-base state are more pronounced in animals in the group exposed to high ambient temperatures. 30 minutes after exposure to high or low temperatures, the indicators in arterial blood were: base deficiency (-10) or (-4); pH –7.28 or 7.36; lactate - 12.44 or 11.25 mmol / l; the partial pressure of carbon dioxide is 38 or 26 mmHg, respectively. The survival rate of animals with hemorrhagic shock when exposed to high temperatures is lower than when exposed to low ambient temperatures (0 out of 4 and 2 out of 4 animals, respectively).

Conclusion. Infusion therapy can reduce mortality when exposed to high and low temperatures. When providing assistance to the injured and wounded, it is necessary to take measures to protect them from high-temperature and low-temperature environmental factors, using shelters and thermal insulation blankets. These measures will reduce the consequences of blood loss and lead to a more favorable course of traumatic illness.

Introduction. Extragenital endometriosis is a rare pathology with nonspecific and variable symptoms and the possibility of establishing a final diagnosis only based on the results of IHC studies. Treatment is either surgical or conservative, and the criteria for choosing tactics have not yet been fully determined.

Clinical case. During the clinical examination, the patient revealed the formation of the right ovary and the formation of the right iliac region, assessed by ultrasound, CT of the abdominal cavity with intravenous and oral contrast, colonoscopy as an invaginate of the phlegmonous altered appendix. A hybrid operation was performed: laparoscopic resection of the dome of the rectum under endoscopic control, cystectomy on the right, enucleation of the capsule of the endometrioid cyst of the left ovary. The results of the IHC study revealed endometriosis of the intestinal wall. In the postoperative period anti-relapse therapy was prescribed.

Conclusions. This clinical case demonstrates the problems of diagnosing extragenital endometriosis, as well as the advantage of surgical treatment, in particular, hybrid laparoscopic-endoscopic, in case of hard-to-reach localization of the formation for final morphological verification.

Introduction. Arteriomesenteric compression of the DPC leads to the development of a chronic violation of the passage of food through the digestive tract with the development of duodenal obstruction in 3-17% of cases. This is a symptom complex caused by compression of the lower horizontal part of the duodenum by the upper mesenteric artery extending from the aorta at an acute angle. Compression of the DPC occurs when the angle of departure of the VBA (upper mesenteric artery) from the aorta is less than 20°, although it is normally 30-50°. Various methods of surgical interventions are proposed. At the same time, operations on the superior mesenteric artery and aorta, which are undoubtedly of an etiopathogenetic nature, are represented by rare clinical observations.

Clinical observation.The article presents a clinical description of the successful use of vascular technologies in the curation of Wilkie syndrome in a patient M. 30 years old with an infrarenal transposition of the superior mesenteric artery. Our first experience of surgery for the transposition of the superior mesenteric artery into the infrarenal aorta in Wilkie syndrome has shown its high efficiency and low injury rate.

Conclusion. This type of surgical intervention should be performed in clinics with significant experience in both abdominal and vascular surgery.

Introduction. This article describes the method of applying kinesiotaping and its advantages when compared with rigid immobilization with a gypsum / thermoplastic splint. It describes the method and describes its role in the rehabilitation process in patients with purulent-inflammatory diseases of the fingers and hand. The result of a comparative analysis of the applications of kinesiotaping and immobilizing plaster/thermoplastic bandages in two equivalent groups of patients with the above pathology is presented. The aim of the study is to conduct a comparative analysis of the treatment of patients with purulent-inflammatory diseases of the hand and fingers, using traditional methods of treatment and kinesiotaping in the early postoperative period.

Materials and methods. A clinical study was conducted based on the treatment of 131 patients with purulent-inflammatory diseases of the hand. The study was conducted in the early postoperative period.

The results of the study showed a high efficiency of using kinesiotaping in the early postoperative period in order to combat pain, edema, improve microcirculation and create favorable conditions for wound healing and reduce the time of hospitalization.

Discussion. The use of kinesiotaping, in the early postoperative period in patients with surgical infections, allows to improve lymph flow and microcirculation, thereby reducing the severity of local signs of inflammation. The use of tapes creates a "soft" immobilization and makes it possible to start rehabilitation measures early by reducing the traumatization of the postoperative wound during dressings. As a result, it was possible to reduce the average period of hospitalization of patients and to perform the social and labor adaptation of the patient more quickly.

Conclusions. Thanks to kinesiotaping, it is possible to create a "soft" immobilization, give the affected limb a calm and physiological position and begin rehabilitation in the early postoperative period.

Critical limb ischemia (CLI) is a manifestation of peripheral artery disease (PDA) in patients with typical chronic ischemic resting pain or ischemic skin damage in the form of ulcers or gangrene, objectively confirmed by occlusive artery diseases. CLI has a high risk of painful (at and above the ankle) amputations, cardiovascular events and death. Ultrasound Doppler, ultrasound duplex scanning, non-invasive (MRA and CTA) angiography help determine the appropriateness and tactics for arterial revascularization. Reconstructive and reconstructive operations in the form of open and hybrid operations are the most successful when applying good quality autovena with a diameter of 3.0-3.5 mm. Balloon angioplasty and stenting form the basis of endovascular methods, drug-coated stents and drug-coated balloons provide a low frequency of repeated revascularizations. In patients with distal lesions of the arteries, if it is impossible to conduct direct revascularization, indirect methods of revascularization are used. Drug treatment before vascular surgery, perioperative period and long-term after surgery is aimed at risk factors for atherosclerosis and thromboangiitis obliteration, promotes wound healing, reduces the frequency of cardiovascular events and death. The state of the gene and cell therapy for the treatment in subset of patients with CLI not eligible for revascularization is reported

Introduction. Inguinal hernia is most common disease in structure of external abdominal hernias. Around the world, approximately 20 million patients with inguinal hernias are operated on annually. According to statistics, 13% of all hernia repairs in world are performed for recurrent inguinal hernia, regardless of method of hernioplasty.

Methods. Traditional methods of autoplasty of inguinal hernias are currently not recommended for use due to large number of relapses. Endoprosthetics according to Lichtenstein attracts with its easy and convenient execution technique, a low number of relapses – about 1,9 % of cases with small primary hernias, and with recurrent hernias reaching 10–15 % of cases. In addition, after it, in the long term, a number of specific problems are observed – 8– 15 % of cases, which significantly reduce the quality of life of patients and cause dissatisfaction with treatment. Alloplasty with TAPP and eTER methods is not recommended in patients with complex hernias and concomitant pulmonary heart diseases. With them, chronic pain syndrome reaches 23 %, and relapses from 12,0 to 13,5 % of cases. An important factor is their high cost.

Findings. The search for new methods for hernioplasty of inguinal hernias is justified. Prospective methods of autoplasty of posterior wall of inguinal canal: Desarda operation; hernioplasty using functional muscle tissue; with relaxing incisions and consolidation of autoplasty with autodermal grafts. With these methods, number of relapses is comparable to the results after alloplasty: postoperative complications were 2,3 %, and relapses were 1,3 %.

Introduction. Purpose. Study the mechanisms of occurrence and the imaging characteristics of spontaneous intramuscular hemorrhage in patients with COVID-19 viral pneumonia.

Methods. The anamnesis, clinical and laboratory data and the results of computed tomography of 28 patients with spontaneous intramuscular hematomas associated with viral pneumonia were analyzed.

Results. According to computed tomography, 36 spontaneous hematomas of muscles and soft tissues of various localization were diagnosed (7 patients had multiple hematomas), mainly in women, the average age of the patient was 75 years. No arterial sources of bleeding were detected by contrast enhanced computed tomography. There was no correlation between the volume and timing of the development of hematomas with anticoagulant therapy. The appearance of 57.1% of hematomas after the 21st day from the onset of the disease was noted. In dynamics, the volume of hematomas didn’t increase and did not require surgical intervention.

Conclusion. Spontaneous intramuscular hemorrhage is a rare complication of COVID-19 viral pneumonia, leading to an unfavorable outcome only with a large volume of hematoma. Surgical treatment of hematomas is not required. The development of spontaneous hematomas can be influenced by both the prescribed anticoagulant therapy and the direct effect of the SARS-CoV-2 virus on the blood coagulation system and the endothelium of the wall of small vessels.

Introduction. The article describes the unique experience of creating an infection center in a short time.

Materials and methods. Since its opening on April 17, 2020 to March 2021, more than 12288 people have been successfully treated and more than 550 people continue treatment every day. To date, the center has deployed 500 infectious and 150 intensive care beds. In order to provide emergency care to patients with surgical pathology, an operating unit was equipped inside the hospital.

Discussion. During 12 months, 442 surgical procedures were performed. Of these: tracheostomies 304 (60 %), drainage of pleural cavities 38 (8,5 %), thoracocentesis 42 (9,5 %), diagnostic laparoscopies 10 (2,2 %) conversions and surgical interventions for perforation of the colon and small intestine, stomach, spleen abscesses 10 (2,2 %), vascular operations with the involvement of city services and specialists from the main base 8 (1,8 %), autopsies of phlegmon, soft tissue abscesses, necrectomies with extensive bedsores 26 (5,8 %), other surgical interventions 4 (0,9 %).

 Conclusion. The design of infectious hospitals for the treatment of patients with a new coronavirus infection should include the possibility of placing an operating unit with an operating room to provide surgical care in emergency and urgent situations on the ground.