Introduction. Since the beginning of the spread of Covid-19, publications have appeared regarding pneumomediastinum against the background of coronavirus infection, but the data in them are insufficient. Pneumomediastinum against the background of the spread of Covid-19 can be a source of serious concern for clinicians.

The aim of the study is to present data on new, frequent observations of pneumomediastinum, combined with pneumothorax and hydropneumothorax in patients with Covid-19, with various clinical manifestations and course, as well as to determine treatment tactics.

Materials and method. A study of the treatment results of 5301 patients with Covid-19, aged 19 to 104 years. Pneumomediastinum was confirmed by computed tomography. All patients with pneumothorax, pneumo-hydrothorax and empyema pleura were drained using the Pleuracan drainage system (B.Braun) or silicone drains, followed by active aspiration.

Results. Pneumomediastinum did not require any interventions in any case, against the background of the treatment, the situation was resolved independently, as the air resorbed. In pneumothorax, active aspiration was carried out until the lung was completely straightened to achieve reliable sealing, from six days to two weeks. All 26 patients with pneumothorax who were on mechanical ventilation died, but in no casepneumothorax was the direct cause of death.

Conclusion. Pneumomediastinum, especially in combination with pneumothorax, can complicate the course of severe coronavirus infection. Combination with pneumothorax requires drainage of the pleural cavity, at the same time, the pneumomediastinum needs only conservative management. In all cases the least traumatic and safest methods of treatment should be chosen.

Introduction. In total pancreatectomy, the main difficulty of stomach preservation was main vein preservation, especially the left gastric vein. The purpose of this study is to research all the variants of left gastric vein anatomy and prevention of its injuries while performing TP in the modification of the surgical clinic of Botkin Hospital.

Materials and methods. A retrospective analysis of the results of total pancreatectomy in patients with pancreatic tumors was carried out in the surgical clinic of Botkin Hospital from September 2007 to November 2022. During the development and implementation of pylorus-preserving total pancreatectomy with spleen preservation in the modification of Botkin Hospital, aspects of the venous anatomy of the stomach, mainly LGV affecting the possibility of performing the modification of TP, were analyzed.

Results. A total of 52 pancreatectomies were performed, including 27 pylorus-preserving total pancreatectomies. The most common LGV variant was Ip type, in which LGV passes behind the CHA. This anatomy variant of LGV was observed in 25 patients out of (48%). In 11 (21,2%) patients, LGV was damaged intraoperatively during total pancreatectomy. The incidence of LGV injury differed among variable anatomy types of LGV. As a rule, LGV passing posterior to any vessel was injured more often than the anterior types of LGV.

Conclusions. Knowledge of the anatomical variants of LGV, preoperative abdominal CT scan in order to inspect the course of LGV leads to prevention of intraoperative trauma of LGV and the increase in number of performed pylorus-preserving total pancreatectomies.

Objectives.To analyze the combined method of surgical treatment of internal hemorrhoids by submucosal laser destruction in combination with Doppler uncontrolled desarterization, mucopexy and electroexcision of the external component according to indications in comparison with traditional electrosurgical techniques.

Material and methods of research. The study included 1386 patients with hemorrhoids of stages 2, 3 and 4, who were divided into three groups depending on the method of surgical treatment. Patients of the first group underwent hemorrhoidectomy according to the Milligan-Morgan method in the 2 modification of the State Proctology Research Institute with the use of an electrocoagulator under spinal anesthesia.

Patients of the second group underwent similar surgical treatment, but with the use of a bipolar electrosection device also under spinal anesthesia. In the third group, all patients underwent submucous laser destruction of internal hemorrhoids with Doppler uncontrolled desarterization, supplemented according to indications with mucopexy and electroexcision of the external hemorrhoidal component. Surgical treatment was performed under intravenous anesthesia. Laser radiation of a diode device with a wavelength of 1,56 microns and a power of 10 W was used.

Treatment results.The hybrid technique reduces the risk of postoperative bleeding due to better hemostasis in the immediate postoperative period and early formation of fibrous granulation tissue in the late postoperative period. Avoids the formation of rough scar tissue.

Conclusion. The technique has technical simplicity, the possibilities of an individual approach to the patient, has no restrictions on the volume and stage of the disease. Reduces the level of postoperative complications, accelerates the rehabilitation period, and improves the quality of life of patients.

Introduction. It is known that pseudocysts (PC) are a consequence of damage to the pancreatic duct in pancreatic necrosis.

The purpose of the study. To study the effect of the depth and configuration of pancreatic necrosis in acute pancreatitis on the dynamics of pancreatic pseudocysts in the long-term period.

Materials and methods. A retrospective analysis was carried out and the long-term results of treatment were studied in 29 patients with PC who underwent pancreonecrosis, in whom the depth and configuration of pancreatic necrosis were assessed on the basis of CT with bolus contrast.

Results. There were no PC complications in 9 patients, no signs of duct damage were noted during acute pancreatitis.In 16 out of 20 patients, PC complications (increasing collections, infection, hemorrhagic complications, rupture) occurred after deep necrosis of type 1 configuration, in 13 they were combined.With not deep necrosis of type 1 (1) and with 2 (3) type of configuration, only infection was noted.At the stage of PC complications, percutaneous drainage (total 12, in 3 after embolization), necrectomy from mini-access (2),endovascular interventions (total 6, 1 patient died), endoscopic cystogastroanastomosis (3) were performed.The result of the interventions in 10 patients was the forced formation of an external pancreatic fistula, which later required additional interventions.

Conclusion. Deep necrosis of the pancreas in type 1 configuration during acute pancreatitis are important criteria determining the likelihood of PC complications.

Introduction. According to the scientific literature, umbilical ring hernias in the structure of operated hernias of the anterior abdominal wall range from 4% to 7%, and their combination with diastasis of the rectus abdominis muscles reaches 60%. Divergence (diastasis) of the rectus abdominis muscles occurs mainly in women who have given birth more than once, etiologically it is caused by muscular dystopia and weakness of aponeurotic elements. The choice of umbilicoplasty largely determines the condition of postoperative scars and the aesthetic result of the operation.

The purpose of the study. Taking into account the anatomical and functional features of the anterior abdominal wall, to improve the results of abdominoplasty performed in patients with abdominal muscle diastasis complicated by umbilical hernias.

Materials and methods. The study included women of the second adult and mature age. By physique, there were 50% exomorphs, 41,7% mesomorphs and 60% endomorphs. All women underwent dermolipectomy, hernioplasty according to K.M. Sapezhko, suturing of the diastasis of the rectus abdominis muscles. 31 women underwent surgery according to the author's method (RF patent 2749475 dated 11.06.21), in 34 – suturing of the distasis and the formation of the non-navel was performed according to the standard method.

Results. In 34 women who had diastasis suturing and dermolipectomy performed by the traditional method in the postoperative period, marginal navel necrosis was diagnosed in two cases, one patient had navel necrosis of 60% and one patient was diagnosed with 100% navel lesion. Navel necrosis was not observed in the study group. In addition, pain syndrome was less pronounced in the postoperative period in women operated by the author's method, and aesthetic satisfaction with appearance was significantly higher than in women of the control group.

Conclusion. The proposed method of umbilicoplasty with suturing of the diastasis of the rectus abdominis muscles avoids navel necrosis and improves the aesthetic satisfaction of patients with the appearance of the anterior abdominal wall.

Introduction. Peptic ulcer is the main cause of bleeding from the upper gastrointestinal tract (GT). Ulcerative bleeding (UB) remains one of the leading diseases in the structure of emergency medical care. The total mortality in this pathology reaches 40% taking into account laparotomies. This the need for further search for optimal treatment methods. One of which is Preventive transcatheter arterial embolization(TAE) in patients with a high risk of recurrent bleeding.

Study purpose. To evaluate the effectiveness of TAE in patients with a high risk of recurrent gastrointestinal bleeding (RGIB).

Materials and methods. The study included 84 patients with UBa high risk of RGIB. The main group consisted of 40 patients who underwent preventive TAE, the control group consisted of 44 patients who underwent TAE after 2 relapses. The number of relapses, laparotomies and mortality rates were compared.

Outcomes. When compared in the main group, there was a decrease in the average stay in hospitalof 6,1 versus 8,3 (p=0,017), the relapse rate of 7,5% versus 27,3% (p=0,002), mortality rates of 1 patient versus 8 (p=0,002), there was no need for laparotomy (p=0,028).

Conclusion. The problem of recurrence of ulcerative bleeding, with subsequent complications up to death, dictates the need for correct and timely stratification of the high risk of recurrent bleeding and determining optimal treatment tactics, leading to a decrease in the number of relapses, laparotomies, mortality. Preventive TAE according to the results of the analysis fully satisfies these requirements.

Introduction. Despite the wide range of complications associated with the use of antitumor therapy, patients often do not receive preventive treatment necessary to correct the consequences for the body.

The purpose of the study. Analysis of the effectiveness of complex rehabilitation programs in patients with skin melanoma after combined treatment.

Materials and methods. The study included 90 patients with metastatic melanoma of the skinwith a history of surgical treatment for the underlying disease; who received immunotherapy with nivolumab or pembrolizumab during the study period. The main group (n=48) included patients who underwent a comprehensive rehabilitation program. Patients who did not complete the rehabilitation program formed a control group (n=42). The effectiveness of immunotherapy was evaluated in accordance with the iRECIST 1.1 criteria. 

Results. Stabilization was registered in 17 (35,4%) patients of the main group and in 16 (38,1%) patients of the control group; the incidence of disease progression in both groups was comparable: 9 (18,8%) cases in the main group and 10 (23,8%) cases in the control group. 

Conclusion. The use of complex rehabilitation programs in the treatment of patients with melanoma demonstrates its clinical effectiveness, however, there are a number of important issues that require further resolution.

Introduction. The introduction of endoscopic intraluminal technologies is one of the current trends in the surgical treatment of patients with gastric subepithelial lesions. The number of publications showing the success of endoscopic operations is growing. Despite this and due to the variable characteristics of these tumors, there is no single algorithm for choosing a technique. 

Aim. To improve the results of treatment of patients with subepithelial lesions of the stomach.

Materials and methods. We retrospectively analysed 74 patients with subepithelial lesions who underwent different endoscopic surgeries in our hospital from 2013 to 2022. 27 patients underwent endoscopic dissections in the submucosal layer, 34 tunnel dissections, 10 endoscopic muscle dissections and 3 full-thickness resections.

Results. All surgical interventions were performed as planned. No intra- and postoperative complications requiring changes in therapeutic setting occurred. Carboxyperitoneum was detected in 17 patients (50%) who underwent tunnel intervention. Only 8 cases (23,5%) required decompression of the abdominal cavity using a Veress needle. Upper GI endoscopy and CT of the chest and abdominal cavity were performed at 6 and 12 months. No recurrence was observed.

Conclusion. The developed algorithm for choosing a technique of gastric subepithelial lesions endoscopic removal allows to gain the correct access to the tumor. As a result of the operation can be performed with minimal time costs and risks of complications. Rapid rehabilitation is an undoubted advantage of endoscopic interventions.

Introduction. Purpose of work: to study the features of lymphotropic therapy against the background of an experimentally created model of ulcerative colitis to improve the result of surgical treatment of this pathology using endomesentericlymphotropic therapy in the postoperative period in the complex treatment.

Material and methods. The analysis of the results of 4 series of experimental experiments performed on 24 outbred dogs was carried out. The aim of the experiment was to model ulcerative colitis, and before and against the background of the created model to study the role of the regional lymphatic system of the abdominal organs in its treatment using lymphotropic therapy. Literature data on the creation of a model of ulcerative colitis in the experiment were studied in detail.The most optimal and acceptable was the chemically induced model of ulcerative colitis, which was caused by rectal administration of acetic acid.

Results. The results obtained with the created model of ulcerative colitis in experimental animals show a sharp slowdown in the rate of lymphatic drainage in the intestinal mesentery by two or more times compared to normal. After lymphostimulation against the background of the created model of ulcerative colitis, lymphatic drainage in the intestinal mesentery improves, while eliminating lymphostasis in the "lymphatic collector", which develops during the inflammatory process.Against the background of lymphostimulation, lymphotropically used drugs contribute to the prevention of possibly developing undesirable complications in the postoperative period. The conducted experiments convincingly prove the positive aspects of the use of lymphotropic therapy in the postoperative period.

Introduction. Long-term non-healing purulent wounds are still relevant and difficult to treat. Using the example of the presented observation, the authors propose an integrated approach using air-plasma treatment, applications of fibrin glue and collagen-containing wound coatings, which made it possible to achieve complete healing of the wound defect of the sacral region in a young patient without resorting to expensive reconstructive plastic aids.

Сlinical case. The 22-year-old patient went to the clinic with complaints of a long-term non-healing purulent wound in the area of surgery. History of repeated surgical treatment for relapse of pilonidal cyst over the past 1.5 years. In the surgical department, complex therapy was carried out: antihypoxant, sanitation and NO therapy, followed by the use of aplications of fibrin glue and autodermoplasty. The patient was discharged on the 17th day with good clinical results, lysis of the transplanted flaps did not exceed 25%. At a follow-up examination after 3.5 months, the former wound defect of the sacral region is completely covered with dense scar tissue.

Conclusion. This clinical case allows us to formulate a new concept of using fibrin glue in combination with stimulating air-plasma treatment of DNGR and a gentle version of autodermoplasty.

Objective. To develop a new technically simple video-laparoscopic method of pelvic floor plastic, which allows to reduce the time required for postoperative rehabilitation, as well as the number of postoperative complications and relapses.

Material and methods. The article presents the results of treatment of 37 patients with total forms of pelvic prolapse using a new method for the treatment of pelvic prolapse developed in the clinic.

Results. When applying the proposed method of plastic surgery of severe forms of pelvic prolapse, no serious complications were obtained in the postoperative period, no recurrence of the disease was noted during 3 years of observation, and an improvement in functional parameters and quality of life of patients was observed.

Conclusion. The method of surgical treatment of total pelvic prolapse and the algorithm for its implementation make it possible to securely fix the pelvic organs in positions approximately corresponding to normal anatomy, eliminate defects in the rectovaginal and cystovaginal septa by replacing with alloplastic material, as well as reduce the number of relapses, postoperative complications, improve the quality of life of patients, reduce the time their hospital stay and speed up rehabilitation.

Introduction. Improvement of a breast reconstruction methods and development of microsurgical techniques allow expanding the options for a reconstructive surgery in patients diagnosed with breast cancer, in light of necessity for the underlying disease treatment.

The purpose of this work is to analyze the literature data describing the methods of the breast reconstruction after a definitive surgery.

Materials and methods of research. Development of technical features, the analysis of the advantages and disadvantages of new reconstruction methods, their comparison with standard options requires further study. 

Results. The role of this technique in the breast cancer complex treatment and the special aspects of the technical performance, depending on the clinical situation in light oftaking necessary measures for the optimal cosmetic effect achievement, are under the research. Such an important factor as the psychoemotional state of the patient at various breast cancer treatment stages has beenconsidered.

Conclusion. The problem of medical, social, labor and psychological rehabilitation of patients who underwent radical breast cancer treatment seems all the more urgent because the contingent of patients has been constantly getting younger in recent years, more and more attention is being paid to such a concept as quality of life, as well as an increase in life expectancy and indicators of general and relapse-free survival against the background of significant success in complex breast cancer therapy.

Introduction. Patients with localized and locally advanced gastric cancercommonly demonstrate high frequency of nutritional deficiency as well as impaired physical status while being in need of complex surgical interventions.This led to the development of “multimodal prehabilitation”concept including physical training, nutritional and psychological support. 

Aim. We aim to summarize recent literature regarding the impact of prehabilitation on the surgical treatment of patients with gastric and gastro-esophageal junction cancer.

Results. Eight studies comprising 347 patients were included. All studies had functional tests as the primary end-point. Studies used a 6-minute walk test or hand grip strength test to measure physical performance. Sixstudies showed an increase in functional capacity in the prehabilitation group,4 studies demonstrated significant improvement of health-related quality of life and 1 study revealed a significant decrease in the level of anxiety and depression (according to the HADS scale) after prehabilitation.All studies did not demonstrate the impact of prehabilitation on postoperative complications and mortality as well as nutrition status of gastric cancer patients.

Conclusions. Heterogeneity of prehabilitation programs as well as the absence of randomized trials preclude wide adoption of multimodal prehabilitation. Standardized prehabilitation programsare neededto further understandthe influence of prehabilitation on the clinical trajectory of patients with gastric and GEJ cancer. Also, the preliminary selection of high-risk patients is required to evaluate the clinical importance of prehabilitation. 

Introduction. The development of means and methods for the emergency elimination of vital disorders at the stages of intensive care helps to reduce mortality, however, even the use of the latest medical equipment does not guarantee the successful outcome of surgical measures, if this does not take into account the regular features of the course of vital processes in conditions of traumatic shock, the stage of development of traumatic illness. The polysystemic and multiorgan nature of lesions in polytrauma determines the variability of measures to provide medical care to the victims. This is due to the lack of a standardized treatment program for such patients at the hospital and pre–hospital stages. The second reason is the fragmentation and inconsistency of data on this topic. A systematic approach that would fully reflect the specifics of the lesions, taking into account the damaged organs and systems, the severity of the condition and the degree of organ dysfunction, is currently in its infancy. Surgical tactics for the treatment of patients with severe injuries does not have clear algorithms. For more than a century, generalized algorithms of surgical tactics have been helping surgeons, resuscitators and other specialists optimize the processes of polytrauma treatment, save the lives of patients who were previously considered hopeless.

The purpose of this article is to present an analytical review of the surgical tactics for the treatment of polytrauma at the hospital stage, which has received the generally accepted name "damage control surgery" or "surgical damage control" based on scientific literature.

Materials and methods. The analysis of domestic and foreign literary sources by keywords on available Internet resources was carried out. More than 60 scientific publications were studied, 39 of them are listed in this article.

Conclusion. Surgical tactics "Damage control surgery" determines the prospect of reducing the mortality of patients with severe traumatic shock and decompensated blood loss. At the same time, there is an increase in the percentage of survival and an improvement in the long–term results of surgical treatment of patients with severe trauma to the abdomen, chest, pelvis, craniocerebral trauma, combined with damage to tubular bones.

At the same time, the number of postoperative complications remains high, clear indications for the use of multi–stage surgical tactics have not been determined, and the optimal timing for performing the stages of surgical treatment has not been determined.

The main milestones of the life and work of Yu.Yu. Janelidze are presented. The merits of a prominent Russian surgeon, academician of the Academy of Medical Sciences of the USSR, professor Yu.Yu. Janelidze, in practical medicine are analyzed. His contribution to the organization of emergency medical care in Leningrad and in the Soviet Union as a whole was noted. The little-known facts from the scientist's life are highlighted. It is shown that in 1932, on the basis of the E.P. Pervukhin Hospital, a scientific and practical institute of emergency medicine was established. The initiator of its creation, Yu.Yu. Janelidze, was approved by the scientific director of the Institute. His great merit was that the Institute became a center of emergency surgery. Yu.Yu. Janelidze sought to introduce the most advanced organizational forms and the best methods of treatment into medical institutions, thereby having a noticeable positive impact on the work of hospitals and clinics not only in the city of Leningrad. It is impossible to overestimate the role of the scientist in the development of emergency surgery in the USSR in the first half of the XX century.