Te bariatric and metabolic surgery for patients with non-severe obesity is steel controversial. But now we have a current trend of expanding indications for this group all over the world. Based on the literature data of PubMed, Medline, Embase, ELIBRUARY, the possibility of developing obesity-associated diseases, as well as socio-psychological problems and a decrease in the quality of life in patients with initial obesity was analyzed. In addition, we analyzed efcacy and safety of bariatric procedures in patients with body mass index less than 35 kg/m2, including ones without metabolic disorders. Indications for surgery are suggested: 1) type 2 diabetes mellitus with insufcient effectiveness of glycemic control with hypoglycemic drugs or insulin and maintaining adequate pancreatic endocrine function; 2) progressive menstrual and fertility disorders as BMI increases; 3) abdomino-visceral form of obesity including without metabolic disorders in case of hereditary predisposition to their development; 4) psychological and social maladaptation, signifcantly reducing the quality of life (psychological rejection of excess weight, dysmorphophobia, bulimia) 5) insufcient effect or its absence from long-term (1 year) conservative treatment.

Introduction. One of the most difcult problems of obliterating diseases of the abdominal aorta and arteries n/a is the variants of multiple and diffuse vascular changes. Te aim of the study was to improve the results of surgical treatment of patients with obliterating atherosclerosis by reasonable use of the deep femoral artery.

Materials and methods of research. Tis paper presents the experience of surgical treatment of 121 patients with the use of HBA plastic surgery (118 men and 3 women) who underwent revascularization in the Department of Vascular Surgery of the University clinic Mikaelian Institute of Surgery" in the period from 2008 to 2020.

Results. In bypass operations on the aorto-iliac-femoral segment, the use of HBA as the only receptive collector in 87.19% of cases makes it possible to achieve an improvement in the clinical status in the immediate postoperative period (in 92.6% with GPID <0.4; in 81.9% with GPID ≥ 0.4 (p < 0.02).

Conclusion. Te reserve potential of the HBA pool, manifested in the dynamics of the postoperative period, allows to compensate for blood circulation during the year afer surgery and preserve the viability of the limb.

Introduction. Te problem of treating patients with postoperative pulmonary embolism is quite relevant at the present time, despite the signifcant improvement in the management of patients with this pathology.

Objective. To evaluate the safety and effectiveness of open embolectomy in the treatment of postoperative pulmonary embolism.

Materials and methods. A retrospective analysis of the case histories of 40 patients who underwent open embolectomy from the pulmonary arteries in conditions of artifcial circulation for postoperative high and intermediate high risk of early death was carried out from 2010 to 2020. Lethality, hemodynamic parameters according to transthoracic echocardiography (EchoCG), postoperative complications and the duration of hospital stay were studied.

Results. 40 patients with 2 fatal outcomes (5%) were operated on. Te average age of the patients was 53.7±8.5 years, 23 people were female. PESI index averaged 106.2±27.3 points, pulmonary artery pressure - 47.7±8.19 mmHg, Miller index – 28.4±3.21 points. Afer surgery, the pressure in the pulmonary artery decreased to an average of 32.9 ± 6.38 mmHg. Te duration of stay in the intensive care unit averaged 1.77± 0.78 days, the duration of the ventilator - 849.3 ± 404.34 min. Te average hospital stay was 13.4±3.43 days.

Conclusion. Open surgical embolectomy is an effective and safe method of treatment of postoperative high and intermediate risk of death PE.

Introduction. Despite the improvement of surgical treatment methods, the formation of postoperative incisional hernias remains a fairly frequent complication afer laparotomy.

Aim. To evaluate the results of treatment, complications and the quality of life in patients afer posterior component separation.

Material and methods. Te article presents an analysis of complications and quality of life in 95 patients with giant incisional hernia who underwent posterior component separation. Te characteristics of patients, polypropylene mesh, fxation method, as well as complications and quality of life are described. Te Clavien-Dindo scale was used to classify and detail complications in the frst 30 days. Te patients ' quality of life was assessed using the EuraHS Quality of Life score questionnaire.

Results. Wound complications were 2.1 %, General complications (pneumonia, lower limb vascular thrombosis) 7.4 %, hernia recurrence 3.1 %, and death 1.0 %. In most patients, 3 months afer surgery, there is a signifcant decrease in the intensity of pain, satisfaction with appearance, and an increase in physical activity.

Conclusion. Te results of the study showed a low percentage of wound complications, relapse, and a signifcant improvement in the quality of life.

Introduction. Nowadays, component separation is the surgery of choice for treating patients with incisional hernia.

Aim. To evaluate the results of treatment, complications and the quality of life in patients afer anterior component separation.

Material and methods. Te article presents an analysis of complications and quality of life in 96 patients with incisional hernia who underwent anterior component separation. Te characteristics of patients, polypropylene mesh, fxation method, as well as complications and quality of life are described. Te Clavien-Dindo scale was used to classify and detail complications in the frst 30 days. Te patients ' quality of life was assessed using the EuraHS Quality of Life score questionnaire.

Results. Wound complications were 11.4 %, general complications 4.2 %, hernia recurrence 1.0 %, and death 1.0 %. In most patients, 3 months afer surgery, there is a signifcant decrease in the intensity of pain, satisfaction with appearance, and an increase in physical activity.

Conclusion. Te results of the study showed a low percentage of wound complications, relapse, and a signifcant improvement in the quality of life.

Introduction. Te number of studies comparing the levels of bacterial contamination of the biliary tree and the sensitivity of the resulting bacteria to antibiotics in cultures of bile obtained from primary and repeated endoscopic retrograde cholangiography (ERCG) is extremely limited, but the study of this issue can signifcantly affect the tactics of treating obstructive jaundice.

Te purpose of the study. Compare the microbiological picture of bile and the sensitivity of the main pathogens to antibiotic therapy in primary and repeated endobiliary interventions with the determination of the clinical signifcance of the method.

Study material and methods. Te study included 43 patients with ERCG with  strictures of the terminal choledochus (20 patients with a history of ERCG, 23 patients with frst-time ERCG). Te titers of the identifed pathogens and the sensitivity of the main pathogens to antibiotic therapy were compared.

Outcomes. 86,96 % of positive cultures were detected during primary interventions and 100 % during repeated ones. Te most common bacteria are Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae). Obligate anaerobes were not detected in any of the cases. E. coli and K. pneumoniae have shown polyresistance to most antibacterial drugs.

Conclusion. Te introduction of bile sampling during endobiliary interventions for microbiological analysis with the determination of sensitivity to antibiotics in clinical practice can signifcantly affect the choice of empirical and etiotropic antibiotic therapy and improve treatment outcomes. Te polyresistance of bacteria determines the importance of conducting similar studies in other hospitals in order to rationally prescribe antibacterial drugs

Introduction. Purpose of work. To improve the results of treatment of operated patients with abdominal surgical pathology by using endomesenteric lymphotropic therapy in the complex of treatment in the postoperative period.

Material and methods. Te analyzis of the results of surgical treatment of ulcerative colitis and acute peritonitis of various genesis in patients who were it the clinic of the Andijan State Medical Institute for the period from 2010 to 2020. Te patients were divided into two groups: the control group included patients (n=93) who received traditional methods of treatment in the postoperative period, and the patients in the main group (n=98) were added endomesenteric lymphotropic therapy to the treatment complex.

Results. Analysis of endomesenteric lymphotropic therapy for abdominal surgical pathology in the postoperative period in a hospital setting shows that the use of this method contributes to the fastest restoration of the functions of the gastrointestinal tract. At the same time, on the 2rd day, intestinal peristalsis and gas discharge are resumed on the 3rd day, in contrast to the patients of the control group, in whom the functional ability of the gastrointestinal tract is restored on the 4th-5th day. Leukocytosis in the blood of patients of the main group signifcantly decreases on the 3rd day, and in the control patients – on the 6th day afer the operation

Introduction. Te Kocher incision remained the only adequate access for operations on the thyroid and parathyroid glands for over 100 years. Te development of technologies made it possible to develop and introduce into clinical practice minimally invasive approaches to the endocrine organs of the neck, one of which is the endoscopic transaxillary.

Purpose of the study. To evaluate the results of the frst experience of performing endoscopic operations on the thyroid and parathyroid glands.

Materials and methods. From September 2018 to June 2021, 52 transaxillary endoscopic operations on the thyroid gland and 6 endoscopic parathyroidectomies were performed at the Department of Surgery of the Central Clinical Hospital of the Russian Academy of Sciences. Among endoscopic operations on the thyroid gland, 26 thyroidectomies, 17 hemiterioidectomies, and 9 extirpations of the thyroid lobe with an isthmus were performed.

Results. Te average time to perform endoscopic operations on the thyroid gland ranged from 82,5–12,1 minutes for hemithyroidectomy to 117.5–21.6 minutes for thyroidectomy about thyroid cancer. Te average bed-day was 4.5 ± 1.2 days. During the frst two days, all patients noted a slight pain syndrome, which was stopped by NSAIDs. Te main advantage of the operation, according to patients, was the absence of an incision in the neck. At the stage of mastering the technique, 2 intraoperative and one postoperative complications were noted.

Conclusion. Te frst experience in performing endoscopic transaxillary operations has shown the promising and safe access provided that the standard surgical technique is followed.

Introduction. Esophageal cancer is one of the most unfavorable diseases of the digestive tract, with a high mortality rate.

Te purpose of the study. Te purpose of this work is to increase the effectiveness of surgical treatment of patients with locally advanced forms of esophageal cancer complicated by tumor stenosis and bleeding due to the rational use of minimally invasive technologies at the stage of surgical treatment.

Materials and methods of research. As part of the combined treatment, 2 patients with locally advanced forms of esophageal cancer and cardioesophageal junction were operated on.

Treatment results. Te experience of using laparoscopically assisted transchiatal extirpation of the esophagus in locally advanced esophageal cancer and cardioesophageal transition in two patients with severe concomitant diseases is described. Te possibility of performing operations in patients with locally advanced esophageal cancer and cardio-esophageal transition with subcompensated concomitant diseases is demonstrated, including through a rational combination of laparoscopic technologies and minilaparotomic access.

Conclusion. Endovideosurgically assisted operations are safe and feasible in patients with locally advanced forms of esophageal cancer and cardioesophageal junction, including through the rational use of the possibilities of mini-access. Te endovideosurgically assisted manual makes it possible to expand the indications for surgical treatment in comorbid patients

Introduction. In recent years, more and more references to diastasis recti abdominis muscles (DRAM) and the problems associated with it have appeared in the medical literature. If earlier it was believed that diastasis is just an aesthetic problem, now there are already publications that say that diastasis significantly reduces the quality of life of patients and is a risk factor for hernias of the anterior abdominal wall. In connection with the actualization of the problem, the surgical activity in this pathology has also increased, which requires a thorough study of the concept of DRAM.

Te purpose of this work is to analyze the current problems associated with DRAM and its surgical correction.

Materials and methods. Conducted a search and analysis of literature sources by keywords in the international abstract database PubMed.gov, as well as the Russian RSCI system over the past 10 years, was carried out. More than 30 scientifc publications have been studied.

Results. A number of studies were analyzed, in which a total of 821 patients were operated on with various minimally invasive techniques and various statistical data were obtained.

Conclusions. Minimally invasive methods for the treatment of diastasis recti abdominis muscles in combination with various ventral hernias have well-known advantages over traditional open ones and should be the method of choice when deciding on the surgical treatment of this group of patients.

Violation of the mesenteric circulation, including both acute and chronic forms, still remains an important difcult-to-diagnose surgical problem, accompanied by high mortality rates. Te share of various forms of mesenteric ischemia accounts for about 1:1000 emergency hospitalizations in Europe and the United States, and in Japan this fgure is estimated at 1:10,000. According to the literature data, it is known that CIOP syndrome is established only in 16,6 % of patients, and then only afer lengthy examinations. In 60 % of patients with CIOP syndrome, acute mesenteric insufciency develops, the mortality from which is 65–95 %.

Tis literature review was carried out in order to fnd the most informative method for early laboratory diagnosis of intestinal ischemia. Te necessity to minimize the diagnosis time of mesenteric ischemia, drives studies aimed to create new markers that, by changing their concentration, indicate ischemia of the intestinal wall and make it possible to perform surgical treatment as soon as possible.

A similar diagnostic potential has a laboratory indicator - the intestinal form of an intestinal fatty acid binding protein (I-FABP), the sensitivity and specificity of which, according to various authors, is 80 % and 85 %, [18] and 79% and 91,3 % [19], respectively.

Te study of I-FABP is promising, and optimization of the algorithm for diagnosing patients with suspected mesenteric circulatory disorders by determining the level of this marker will help reduce the time for diagnosing this pathology, improve the results of treatment of patients, their quality of life in the postoperative period, and reduce mortality.