Introduction. Currently, the success of the treatment of neoplasms of the pancreatoduodenal zone is largely due to the surgical stage. The incidence of pancreatodigestive anastomosis failure after performing gastropancreatoduodenal resection (GPDR) ranges from 1% to 58%.
   The purpose of the study. To improve the results of surgical treatment of patients after GPDR by using long-term skeletal drainage of pancreatoejunonastomosis.
   Materials and methods. The experience of the general surgery clinic is 32 gastropancreatoduodenal resections. In 29 cases, the operation was performed for malignant tumors of the head of the pancreas, which amounted to 90,6 %. For cancer of the large duodenal papilla, 3 surgical interventions were performed. According to the TNM classification (2010), stage I and II of a malignant tumor were detected in 75 %, and stage III was diagnosed in 25 % of cases. Decompression of pancreatic and biliodigestive anastomoses was performed using long-term skeletal drainage of the main pancreatic duct by Felker in 27 patients (84,4 %). In five cases, an ivagination PA was applied (15,6 %).
   Treatment results. In 6 (23,6 %) patients who underwent GPDR with long-term skeleton drainage, the failure of PEA was diagnosed early, with the formation of pancreatic fistula type "B". Of the 5 patients who did not undergo skeleton drainage, 3 patients had uncomplicated postoperative period. In two (40 %) observations, "C" type fistulas developed.
   Conclusion. Improvement of postoperative GPDR results can be achieved through the use of long-term frame drains.

   Introduction. The progression of neurovascular syndrome leads not only to temporary disability, but also often to disability of the patient.
   The purpose of the study: to evaluate the effectiveness of various options for stage-by-stage treatment of neurovascular syndrome.
   Materials and methods. The present study is based on the analysis of the examination results of 155 patients with neurovascular syndrome. At the first stage, all patients underwent conservative therapy, and later, if necessary, surgical treatment was performed. 136 (87.7 %) patients received inpatient treatment and 108 (69.7 %) were operated on. All of them were observed in the vascular surgery department of the Republican Clinical Hospital of the Ministry of Health of the CBD in the period 2000-2018. Against the background of conservative treatment for 5 years, an aggravation of clinical manifestations occurred in 67.7 % of patients. We performed surgical intervention on these patients. Distal periarterial sympathectomy allowed to obtain a 10-year positive result (without relapse) in 34.2 % of patients. Subsequently, 59.4 % of patients underwent proximal periarterial sympathectomy.
   Results. During 68.3 ± 8.2 months after distal sympathectomy, 40.6% of patients had no manifestations of chronic upper limb ischemia.
   Discussion. Most authors tend to believe that secondary neurovascular syndrome prevails in FR. However, according to some epidemiological studies of a healthy population, up to 89% of people with FR have primary FR, while in the study of clinic patients secondary FR is more often detected (50-70 %).
   Conclusion. Thus, our study demonstrated that staged minimally invasive surgical treatment can delay the onset of severe upper limb ischemia.

   Introduction. Obstructive sleep apnea syndrome (OSA) is a common disease in patients with morbid obesity. The prevalence of OSA among obese patients varies from 60 to 90 %. The need for CPAP-therapy as part of the complex perioperative rehabilitation of patients with morbid obesity and severe OSA is undeniable. There are a large number of dedicated to the perioperative management of patients with obesity and OSA, but never give specific dates for preoperative assessment.

   The aim of this study was to evaluate the dynamics of the quality of life in patients with obesity and severe OSA against the background of optimizing the tactics of perioperative rehabilitation.
   Materials and methods of research. Dynamics of the quality of life was studied in 70 patients with morbid obesity and sever OSA at various stages of perioperative rehabilitation using the SF-36 questionnaire; enhanced perioperative rehabilitation was used in relation to 35 patients.
   Treatment results. There was a positive trend in the level of quality of life in patients of both groups at each of the stages of study. Enhanced perioperative rehabilitation used in patients of group I; the quality of life in these patients did not differ from those in the group of healthy people after 12 months.
   Conclusion. The use of the enhanced perioperative rehabilitation contributes to a more rapid improvement in the quality of life of patients in comparison with the perioperative rehabilitation with an intragastric balloon implantation.

   Introduction. The purpose of the study. To reduce the incidence of wound complications after kidney transplantation (KT) by using intraoperative sanitation of the bladder cavity (ISBC).
   Materials and methods of research. The study included 90 patients who underwent KT from 2020 to 2021. At the first stage, we determined the frequency of wound infection (WI) and assessed the significance of risk factors for its development, at the second stage, we determined the presence of asymptomatic bacteriuria (AB) when placed on the waiting list and immediately before the operation for each observation. At the third stage, patients with AB (n = 34) were divided into two groups depending on the use of ISBC 0,2 % antiseptic solution based on polyhexanide.
   Treatment results. At the time of placement on the waiting list, AB was recorded in 42 / 90 patients (47 %), at the time of surgery – in 34/90 (38 %). WI developed in 13 / 90 (14 %) patients. When comparing the frequency of WI depending on the presence of AB, statistically significant differences were obtained (p = 0,027). In the first group of patients with AB, where ISBC was used, WI developed in 2 / 18 (11 %) patients, in the control group (without the use of ISBC), in 7 / 16 (44 %) patients. We have identified a trend towards a decrease in the frequency of RI with the use of ISBC (p = 0,052).
   Conclusion. ISBC with an antiseptic solution based on polyhexanide makes it possible to achieve the eradication of pathogenic flora in the urinary tract, which reduces the risk of contamination of the surgical wound and the development of WI.

   Background. Today it is necessary to reduce the burden on surgical departments of hospitals by limiting the number of minor surgeries and expanding the possibilities of outpatient surgery which can reduce the stay in a medical institution to just a few hours.
   Objective. To substantiate the effectiveness of surgical treatment of hernias of the anterior abdominal wall in the day patient department of a clinic during 3 years in order to confirm its clinical and economical effectiveness in combination with the accelerated recovery program.
   Methods. The one-day surgery program has been implemented at the Rostov Clinical Hospital since 2019, together with the accelerated recovery program at the day patient department of the clinic. The day patient department has 10 beds, an operating room with anesthesia equipment and an anesthesiologist. Patients receive treatment in accordance with the multimodal accelerated recovery program (ARP). 154 hernioplasty surgeries were performed in the day patient department by the program during 3 years. After surgery, patients were placed in the day patient department wards. A few hours later, after full activation, they were allowed to go home without being accompanied by a medical worker. The patients were surveyed to clarify their satisfaction with the program on a 5-point scale.
   Results. With equal costs for medicines and examination, due to the cost-intensity ratio, the treatment of patients according to the CSG "Hernia surgery, adults (level 3)" was more cost-effective in the day patient department of the clinic (ds32.005 – 3.24) than in the in-patient department (st32.015 – 1.78). The satisfaction with the one-day surgery program was high (4.76), confirming its effectiveness.
   Conclusion. The one-day surgery program in combination with the accelerated recovery program expanded the use of the day patient department for the surgical treatment for anterior abdominal wall hernias, being as effective as standard treatment in the hospital.

   Introduction. The number of patients with acute and chronic pancreatitis is steadily growing. The average age of patients with pancreatitis is currently 39 years. The percentage of disability in patients with this pathology has increased to 15 %. One of the options for complications in patients with chronic pancreatitis is the development of postnecrotic pancreatic cysts.
   The purpose of the study. To improve the results of surgical treatment of patients with pancreatitis, complicated by the development of postnecrotic pancreatic cysts of various localization, through the use of laparoscopic minimally invasive cystogastrostomy.
   Materials and methods. The article analyzes the results of surgical treatment of 27 patients with postnecrotic pancreatic cysts of various localization, who underwent surgery in the scope of laparoscopic minimally invasive cystogastrostomy.
   Treatment results. The presented method of surgical treatment of patients with postnecrotic pancreatic cysts was effective in 25 patients, one patient had a relapse. In one patient, it was not possible to evaluate the results of treatment due to a lethal outcome.
   Conclusion. Laparoscopic minimally invasive cystogastrostomy is an alternative surgical treatment option for patients with postnecrotic pancreatic cysts of various localization, for whom other options for minimally invasive and resection operations are undesirable or impossible due to some topographic and anatomical features of the patient.

   Introduction. In modern state, the number of victims with penetrating abdominal wounds remains at the level of 5 to 22 % according to various sources [1, 2]. However, not all of them are accompanied by injuries to internal organs, only 75,9–87,7 % of them require invasive surgical treatment [3, 4]. Currently, in the clinical practice of large hospital centers, the leading trend has become the reducing the level of surgical aggression and the correct choice of patient management tactics.
   Purpose. Improving the effectiveness of the treatment of hemodynamically stable patients with penetrating stab wounds with diagnosed coronavirus pneumonia through the use of a selective approach and nonoperative management.

   Methods. A clinical case of the use of selective non operative management in one patient with penetrating stab abdominal wounds in combination with pneumonia of viral etiology is considered.
   Results. The possibility of effective treatment of a patient according to the protocol of nonoperative management with concomitant lung lesions in a new coronavirus infection has been demonstrated.
   Conclusion. A selected approach and nonoperative management in hemodynamically stable patients with penetrating abdominal injuries are also applicable if the patient has concomitant coronavirus pneumonia and allows avoiding "unnecessary" extensive surgical interventions, thereby reducing the risk of postoperative complications against the background of infiltrative changes in the lungs.

   Introduction. Biological agents such as bevacizumab with anti-VEGF (vascular endothelial growth factor) alone or in conjunction with chemotherapy increase the risk of bowel perforation. The eLibrary query "bevacizumab" received 202 publications, but no reports of bowel perforation during treatment with this drug were found.
   Clinical case. Here is a clinical case of surgical treatment of a patient with tumor perforation of the transverse colon, recurrent perforations of the duodenum and jejunum on the background of bevacizumab therapy.
   Discussion. Bowel perforation due to tumor necrosis and direct damaging effects on the intestinal wall is indicated as a possible complication of bevacizumab therapy. Kidney-cell and generalized colorectal cancer, unresectable primary tumor, therapy with high doses of bevacizumab (5 mg/kg), colonoscopy within 1 month after initiation of therapy, and prior radiation therapy are risk factors for perforation.

   Conclusions The results of surgery and nonoperative treatment of gastrointestinal perforations against the background of bevacizumab therapy are considered.

   Introduction. Together with the development of the methods for surgical removal of the breast the methods of its restoration have been improving as well. It should be considered that the purpose of a breast reconstruction is to recreate a natural, plastic form and maximum symmetry, so the surgical treatment is chosen individually, taking into account the patient's anamnesis and anatomical features. These tasks allow solving various methods of autologous reconstruction, where flaps of the anterior abdominal wall (both in a single-stage and in a delayed version) are gold standards today. The question of the degree of injury to the donor zone is one of the important links while choosing a flap harvesting option.
   Discussion. The article presents a clinical case and describes in detail the simultaneous reconstruction with a free MS-TRAM flap (Muscle-Sparing Transverse Rectus Abdominis Myocutaneous flap) – a muscle-sparing variant of flap lifting, which is a good alternative to the DIEP flap in case of technical difficulties, coming from the topographic and anatomical features of vessels and occurring during a surgery.
   Conclusions. This technique reduces the likelihood of postoperative complications at the donor zone and, in some cases, may exclude the use of a mesh implant. There is no substantial difference in performing the "sit-up" test during the postoperative period in the case of transplantation of DIEP and MS-TRAM flaps.

   Introduction. In this literature review, the causes leading to the development of complications and treatment options for early and late purulent-septic complications are considered. Modern methods of using mesh implants have reduced the number of hernia recurrences, but the number of early and late postoperative complications has increased. However, there is no consensus on the treatment of late postoperative complications after hernioplasty.
   Purpose of the study. Explore and analysis of the available literature on complications and their treatment after hernioplasty.
   Materials and methods. This is analysis of the available literature and publications on the Internet over the past 10 years has been carried out. 30 publications were explored.
   Conclusion. The literature available to us describes several reports of the occurrence of late postoperative complications after hernioplasty with a mesh implant and the use of NPWT therapy.

Treatment of occlusive lesions of the arteries of the lower extremities remains an urgent problem, leading to permanent disability, and even death, and therefore it is rightfully considered one of the most dangerous conditions in the group of diseases of the circulatory system. This review article presents various treatment methods and their comparative analysis, which makes it possible to choose less traumatic and more effective methods aimed at reducing the frequency of amputations of the lower extremities. Such as bypass surgery and balloon angioplasty with or without a stent; application of the angiosomal theory of limb revascularization; tactics of aggressive surgical wound rehabilitation or staged low-traumatic bandages; vacuum therapy in the treatment of trophic ulcers; comparative analysis of single-stage and multi-stage amputations in critical lower limb ischemia. As a result of the analysis of the literature, it can be stated that the treatment of CINK is based on: 1. Adequate revascularization with obtaining a main or collateral blood flow in the area of trophic defects; 2. Proper wound care, using aggressive methods of removing dead tissues and vacuum dressings; 3.Staged (small) amputations as necessary.

   Introduction. Chronic kidney disease (CKD) is a serious disease, the most common causes of which are obesity, diabetes, metabolic disorders, cardiovascular disease, and others. Approximately 10 % of adults worldwide have chronic kidney disease, resulting in 1,2 million deaths each year. Epidemiological studies have determined the association of obesity with the development of end-stage chronic kidney disease and the risk of hemodialysis sessions.
   The purpose of the study. To evaluate the effectiveness of bariatric surgery in terms of reducing the risks of end-stage chronic kidney disease, as well as improving the quality of life in patients on hemodialysis who underwent surgery for obesity.

   Materials and methods. Literature reviews and articles describing the experience of bariatric surgery in patients with chronic kidney disease and patients on hemodialysis.
   Results. The effectiveness of bariatric interventions in the treatment of morbid obesity and metabolic syndrome has been undeniable and proven. The possibility of treating patients with progressive renal failure in patients with obesity through surgical methods is relevant and discussed. First of all, bariatric surgery.
   Conclusion. Bariatric surgery significantly improves the quality of life and reduces the risk of mortality in patients with chronic kidney disease of any stage.

   Nowadays, there is no questions about the effectiveness of bariatric surgery for weight loss and improvement of the course of the metabolic syndrome. However, their influence on gastroesophageal reflux disease (GERD) and its main symptom – heartburn – remains discutable. Sleeve gastrectomy (SG) is one of the most frequently performed laparoscopic bariatric operations. It is considered that SG may lead to occurrence de novo or escalation of existing symptoms of reflux. But sometimes weight loss after bariatric surgery lead to decrease of such symptoms. In this regard, there is no consensus on whether it is worth considering the existing GERD as an absolute contraindication to the implementation of SG. The effect of gastric bypass (GBP) on the course of GERD seems to be more favorable. At the same time, cases of postoperative deterioration are also described in the literature. This article provides a review of the literature on the natural course and treatment of GERD, the impact of bariatric surgery on the disease, and proposes an algorithm for choosing a surgical intervention based on the review.

   Some historical aspects of medicine of the XIX century in Georgia are presented. The main dates of the life and work of academician of the Academy of Medical Sciences of the USSR G. M. Mukhadze, the scientist's contribution to the development of scientific and practical surgery and urology in the USSR are analyzed. It is noted that G.M. Mukhadze is considered the founder of higher medical education in Georgia. He considered pedagogical activity to be the most important duty of every scientist. His lectures were surprisingly interesting and informative. It is noted that G.M. Mukhadze founded the Republican blood transfusion station in Georgia in 1932. Grigory Mikhailovich had to expend a lot of work and energy to create donor personnel, introduce blood transfusion into medical practice and develop a blood and hematology service in Georgia. It is shown that in his person Soviet medical science has lost a venerable surgeon-innovator, the "founding father" of a brilliant surgical school in Georgia, a tireless, talented teacher and mentor of the younger generation of clinicians.