Introduction. Currently, indications for the choice of the type of transmural drainage (TMD) for pancreatic fluid collection, drainage timing and a dynamic monitoring program for the prevention of relapses and complications have not been formed.

The purpose of the study. To improve the result of treatment in patients with fluid formations of the pancreas.

Materials and methods. The results of using TMD in 54 patients with fluid formations of the pancreas in the period from 2012 to 2022 were analyzed. Active transmural drainage (ATMD) was performed in 38 cases, passive transmural drainage (PTMD) was performed in 16 cases. Long-term results of transmural drainage were evaluated in 29 patients. In 10 observations, the functioning of the internal postoperative pancreatic fistula in the long-term period was studied.

Treatment results. A statistically significant difference was revealed in the clinical success, the frequency of complications when performing active and passive TMD of liquid formations with a density of 15HU. Statistically significant associations were revealed between the TMD method, the density of liquid formations, clinical efficacy and the frequency of stent obturation. When assessing long-term results, relapses are observed during migration and removal of the stent earlier than 24 months in the presence of a damaged main pancreatic duct.

Conclusion. The data obtained as a result of the study indicate that the choice of the method of endoscopic drainage of the LV should be carried out based on the results of studying the density of the contents of the liquid formation measured by computed tomography. Thus, with a density of liquid formations ≥ 15HU, it is advisable to perform active drainage using cystonasal drainage. The decision to remove the stent in the absence of liquid formations according to ultrasound and CT is advisable to take after assessing the level of amylase in the cystogastric anastomosis.

Introduction. In order to improve the results of surgical treatment in patients with median postoperative ventral hernias, an original technique of non-tensioning plastic surgery using a polypropylene mesh graft has been developed. A comparative analysis of the results of treatment with a group of patients operated on traditionally was performed.

Materials and methods of research. A retrospective analysis of 129 cases of non-tensioning plastic surgery «onlay» of postoperative ventral hernias of median localization was carried out at the surgery center of GBU RO ROKB. 2 groups of patients were formed. The «main» group included patients after hernioplasty using the original technique of non-tensioning hernioplasty – 63 patients, the «control» group consisted of 69 patients who underwent traditional non-tensioning hernioplasty. The basis of the original technique is the use of a frame thread in the preperitoneal space, which is captured when applying U-shaped sutures that fix the mesh endoprosthesis.

Treatment results. A comparative analysis of the long-term results of operations with follow-up periods from 2 to 55 months showed that out of 63 patients operated according to the original method, there was no recurrence of hernia, while out of 64 patients in the control group, 8 people (12,5 %) had a relapse.

Conclusion. The original technique of hernioplasty «onlay» has statistically proven advantages over the generally accepted method of non-protracted hernioplasty technique «onlay» – the absence of recurrence of hernias for a long time after surgery, is a safe and publicly available method of surgical treatment of patients with postoperative ventral hernias of median localization.

Introducion. Oral intake of nutrients is physiological. However, some patients cannot eat per os. In this regard, there is a need to find alternative options for the introduction of nutrition. In the presence of indications for long-term enteral nutrition, gastrostomy is most preferable.

The purpose of this paper is to show the experience of gastrostomy in adults and children in our clinic, as well as the relative simplicity and advantages of using endoscopically assisted gastrostomy with an assessment of the indications and possible complications.

Materials and methods of research. From July 2019 to October 2022, 50 endoscopically assisted puncture gastrostomies were performed at Ilyinskaya Hospital JSC, five of them in children.

Treatment results. In 97% of patients, gastrostomy tubes in the postoperative period retained their tightness, no obstruction of the canal was observed in 100% of cases. Minor complications were recorded in 8% of cases; large – 6%.

Conclusion. It is necessary to give preference to endoscopically assisted puncture gastrostomy by the Push method using low-profile balloon gastrostomy tubes, which is due to low invasiveness, safety, short duration of intervention and relative ease of its implementation.

Introduction. Bariatric surgery shows excellent results in the treatment of obesity and comorbidities including type 2 diabetes. To predict the effect of surgical treatment of type 2 diabetes mellitus, several scales have been proposed, including DiaRem and Ad-DiaRem.

Materials and methods of research. Based on a retrospective analysis study, 38 patients with type 2 diabetes were identified after bariatric surgery with a follow-up period of at least 1 year. The KNIME Analytics Platform 4.3.6 (KNIME AG, Switzerland) was used for data processing.

Treatment results. Among 38 patients, 12,8 % achieved partial remission of diabetes, 52,6 % complete remission, and 31,6 % did not achieve remission. According to the DiaRem, no significant results were detected in the remission groups (χ2 = 6,76, DF = 4, p-value = 0,15). AUC = 0,744, k = 0,383. DiaRem scale have a low predictive value. A significant result was obtained on the Ad-DiaRem (χ2 = 22,0, DF = 4, p-value = 0,0002). AUC = 0,88, k = 0,632. Ad-DiaRem predictive value is high.

Conclusion. The Ad-DiaRem have a better predictive value. Ease of use, good prognostic effect allows us to recommend Ad-DiaRem before bariatric treatment to. Duration of diabetes mellitus and number of hypoglycemic drugs taken seems to be one of the crucial factors in prognosis of DM remission.

Introduction. The reliability of non-tensioning alloplasty of ventral hernias of median localization is determined by the method of fixation of the mesh prosthesis. The aim of the study was a morphological and biomechanical assessment of the severity of fascial-muscular structures of the anterior abdominal wall in the rectus abdominal muscles in the aspect of the application of an original surgical technique for the treatment of patients with ventral postoperative hernias.

Materials and methods of research. The work was based on anatomical studies of 36 human corpses. Biomechanical parameters of native, scar-modified and reinforced fascial structures of the anterior abdominal wall with a skeleton thread according to the original surgical technique were studied at the ISS-500 stand using the Scaima ZF-500 force sensor. In the course of the study, radiography, computed tomography and ultrasonography were additionally used. Statistical analysis of the data was carried out using the Statistica 10 program.

Results. Five nodes were identified in the muscle-free areas and at the junction of the fascial structures of the anterior abdominal wall, which belong to the target structures of the median part of the anterior abdominal wall involved in the formation of hernias. The tensile strength and modulus of elasticity of the fascial structures of the anterior abdominal wall of various types of fascial structures of the anterior abdominal wall were studied. A comparative analysis of the results of the experiment showed that the highest indicators of tensile strength were in the scaraltered fascia, reinforced with a frame thread according to the original technique.

Conclusion. The proposed and patented technology of surgical treatment of ventral hernias of median localization increases the ability of tissues to withstand intra-abdominal pressure, which prevents the threat of relapse of the disease.

Introduction. The results of the research conducted in the 80s of the twentieth century allowed us to formulate the basic principles of surgical treatment of combined radiation-mechanical lesions (CRMP), however, the possibilities of new therapeutic technologies developed in recent decades in relation to CRMP have not been sufficiently studied. The tactic of non-surgical treatment (NOL) of abdominal injuries with stopped internal bleeding is increasingly used for abdominal injuries, however, we have not found reports of the use of this tactic in CRMP in the available literature.

The aim of the study was to conduct a comparative experimental assessment of the effectiveness of the tactics of NOL and laparotomy in abdominal injuries with stopped intra-abdominal bleeding as a component of CRMP.

Materials and methods. The study was conducted on 41 rabbits of the Soviet Chinchilla breed, males weighing 2,5–3,0 kg. Rabbits were randomly divided into 5 groups depending on the experimental conditions.

The results of the study. The choice of the method of surgical treatment of abdominal injuries with stopped internal bleeding – NOL or laparotomy, modifies the nature of the course of PKK, but not its outcome. It was found that the NOL tactic does not cause the death of animals in the early period of modeling the mechanical component of the CRMP, since it is not accompanied by additional trauma and additional intraoperative blood loss.

Conclusion. The results obtained allow us to assert that the choice of tactics for NOL injuries of abdominal organs with stopped internal bleeding in CRMP in the experiment contributes to a more favorable flow of radiation and mechanical components compared with the results of the classical approach with surgical removal of abdominal injuries.

Introduction. The lesion of peripheral arteries is one of the formidable conditions in the group of diseases of the circulatory system diseases.

Materials and methods. In our study, we formed an isolated group for the treatment of patients without severe infection, but with distal necrosis, which should be removed after the restoration of blood flow. The question of the timing of amputation remains open. Such an operation is possible both simultaneously and in stages. The purpose of this study was to assess the impact of the timing of small amputations on the results of treatment. In the group with simultaneous amputation, we included 26 patients who underwent surgery either simultaneously with bypass surgery or within a day after endovascular revascularization. Delayed amputation of fingers was performed within 5 to 14 days from the moment of revascularization, there were 36 such patients.

Discussion. We did not find statistically significant differences between the long-term results for the presented parameter.

Results. The survival rate during the year was 92 % in the group with simultaneous amputation of fingers and 88 % – with a staged one.

Introduction. In this study, we present a way to reduce the risk of infection of the vascular intervention zone by isolating the wound infection with a vacuum bandage with permanent removal of the exudate into a separate closed circuit.

Materials and methods. In our study, 38 patients underwent open revascularization with critical ischemia. We divided all patients with open interventions into two groups: 18 patients we used VAC systems during surgery (group 1) and 20 patients we operated on with wounds covered with a thick layer ofantiseptic bandages (group 2). Despite the absence of a significant effect on the results of treatment at this stage, we saw a decrease in the frequency of infection of the postoperative wound by 5 times.

Discussion. One of the fundamental clinical manifestations can be noted the rapid appearance of granulation tissue, a decrease in the size of the skin defect, as well as a marked decrease in bacterial contamination of the wound surface.

Results. The method of VAC bandages during vascular operations may be a new way to prevent infection of postoperative wounds in patients with skin defects.

Introduction. The purpose of the study. To evaluate the dynamics of parenchymal thickness deficiency in patients with congenital hydronephrosis operated at different periods of the disease.

Materials and methods of research. A retrospective analysis of the medical histories of 350 patients operated on with a diagnosis of congenital hydronephrosis. According to the protocols of ultrasound diagnostics performed a few days before the operation and in the long-term postoperative period, the coefficient of reduction of the deficit in the thickness of the parenchyma of the operated kidney in patients of different ages was determined. Statistical processing ofof reduction of the deficit in the thickness of the parenchyma of the operated kidney in patients of different ages was determined. Statistical processing of the results was carried out using the analysis package SPSS Statistics 17.0. The results of qualitative parameters are presented in the form of absolute values (abs.) and percentages (%).

Results. A statistically significant dependence of the disease prescription with the dynamics of parenchymal thickness deficiency was found. It was found that in patients with congenital hydronephrosis as a result of surgery performed at the age of one year, the coefficient of reduction of parenchymal thickness deficiency increased statistically significantly with increasing age of the patient at the time of surgery.

Conclusion. In patients with congenital hydronephrosis, with an increase in the age of the patient at the time of surgery, the deficiency in the thickness of the parenchyma of the affected kidney increases.

Introduction. This article is about the immediate clinical case of application the endoscopic stenting of the main pancreatic duct in a patient with acute destructive pancreatitis in the early phase of the disease. Frequent presence of signs of separation of the pancreatic duct system (diagnosed according to the instrumental methods of research), it was decided to use stenting of the main pancreatic duct with a plastic stent.

Discussion. Acute destructive pancreatitis remains an urgent surgical problem due to the persisting significant number of various complications and deaths, despite the progress made in the treatment of this group of patients. Currently, there is a tendency to appear in the publication articles about endoscopic stenting of the main pancreatic duct in the early phase of the disease in patients with signs of separation of the ductal system. In addition, cases of using combined techniques for the most effective treatment of this group of patients are described.

Conclusion. The use of endoscopic stenting of the main pancreatic duct is the best way to treat patients with acute destructive pancreatitis with signs of separation of the pancreatic duct system.

Introduction. Polytrauma is a collective concept that includes multiple and combined, combined injuries that pose a danger to the life or health of the victim and require emergency medical care. Injury occupies one of the leading places in the structure of mortality among the working population in peacetime, and is one of the main causes of death in military conflicts. The polymorphic nature of injuries and the lack of a unified view on the assessment of the severity of the condition are the key problems of this topic. Together, the available scales answer all the main diagnostic questions, but have limitations in terms of speed and ease of use. This article presents an analysis of the main prognostic scales used to diagnose surgical patients with polytrauma.

Conclusion. At the moment, there are many diagnostic scales for assessing the severity of the condition of patients with severe injuries. Some of them and combinations of scales have proven themselves to be the most predictably significant. A group of Russian authors has developed their own diagnostic scale, with the experience of successful practical application.

Introduction. Hand trauma and the hand diseases are the socially significant problems. Septic arthritis of the metacarpophalangeal or interphalangeal joints are prone to aggressive course, with severe complications and inappropriate outcome, that is more likely in inadequately postponed or insufficient treatment. The indications for finger amputation in some studies were up to 26 %. Issues regarding the surgery technique and the rehabilitation approach remain the subject of discussion.

Purpose of the research. To analyze the features and results of surgical treatment, as well as approaches to rehabilitation after septic arthritis of the metacarpophalangeal and interphalangeal joints.

Materials and methods of research. The search and analysis of literary sources in the PubMed, Web of Science, Google Scholar databases, as well as in the Russian Science Citation Index (RSCI) system in the period from 1990 to 2022 was carried out. More than 50 scientific publications have been explored.

Conclusion. The analysis of treatment timing showed that immediate surgical intervention is of critical importance for the long-term result. Persistent dysfunction along with painful arthrosis after septic arthritis of the hand may be the reason for performing arthrodesis of the finger in about 40 % of patients. Immobilization is still a question for discussion: ranges from 24 hours to 4 weeks or more. Public attention should be pointed to the search of an effective strategies of the septic arthritis of the metacarpophalangeal and interphalangeal joints of the hand treatment.

In recent years, there has been growing interest in heterotopiс gastric mucosa (HGM) in the cervical esophagus. The management of patients with symptoms of laryngo-pharyngeal reflux (LPR) is unresolved issue. Methods of treatment are debatable, there are no clear strategies for HGM. Most authors report about low efficiency of conservative therapy. Radical surgical methods are historical in nature. Endoscopic methods of treatment deserve the greatest attention. The most invasive endoscopic approaches of treatment such as mucosal resection and submucosal dissection are used for neoplastic transformations of HGM in cervical esophagus. Argon plasma coagulation (APC) and radiofrequency ablation (RFA) provides good results aimed at eradicating of HGM in the esophagus and clinical symptoms. Pay attention to localization of heterotopia and potential risk of esophageal stricture formation, preference should be given to the safest technique RFA. The variety of minimally invasive technologies of treatment of symptomatic patients with HGM in the esophagus requires further research to develop standardized approach of therapy.

This paper presents the main achievements in our country and abroad in the development of operations on the «dry» heart. The merits of a prominent Russian surgeon, Professor N.N. Terebinsky, were noted. The fact is analyzed that in his work N.N. Terebinsky used the «Autojector» device, invented by the physiologist-innovator and scientist S.S. Bryukhonenko in 1924. This remarkable discovery made it possible for surgeons to perform operations on the septa and heart valves using artificial blood circulation under the control of vision. It is shown that the general cooling of a warm-blooded organism with a highly developed thermoregulation system is very difficult to tolerate and, when the temperature drops to a certain level, leads to the death of an animal and a person. The first studies on this issue, which in the USSR belonged to A.N. Bakulev, P.A. Kupriyanov, V.I. Burakovsky, I.R. Petrov, B.V. Petrovsky, G.A. Ryabov, are analyzed. It is shown that P.A. Kupriyanov for the first time in the Soviet Union (1955) performed an operation on a «dry» heart under hypothermia, removing the fibrous ring under the control of vision with tetrad Fallot. At that time, operations on a «dry» heart under hypothermia posed a danger to the lives of patients and therefore were used in isolated cardiac clinics with caution.