Introduction. The cosmetic effect of endoscopic thyroidectomy is indisputable. However, there are questions about the appropriateness of such an operation. A meta-analysis was performed to summarize data on the advantages of endoscopic over open access in thyroid surgery.

   Aim of the study. To conduct a meta-analysis of the results of operations on the thyroid gland with transaxillary endoscopic (TATE) and open access (OTE).

   Materials and methods. 8 retrospective, 4 prospective and 1 randomized comparative study were analyzed, including the results of treatment of 6484 patients. Statistical processing was performed in the Review Manager 5.4 program. The sum of the dichotomous data was reported with a 95 % confidence interval as an odds ratio. Statistical heterogeneity among the studies included in the meta-analysis was assessed using the χ2 test. At p<0,1 and I2>50 % heterogeneity was considered statistically significant.

   Results. The conducted meta-analysis confirmed the advantage of TATE over OTE in terms of cosmetic results of treatment. With regard to the volume of intraoperative blood loss, the frequency and structure of postoperative complications, TATE was comparable to OTE. There was no statistically significant difference between TATE and OTE in the severity of pain syndrome and the length of stay of patients in the hospital.

   Conclusion. TATE for benign and malignant neoplasms of the thyroid gland is a safe alternative to open surgery. TATE is most effective and safe when performed by an experienced surgeon who has gone through a learning curve.

Introduction. The aim of the study was a morphological and biomechanical assessment of the degree of changes in the target structures of the lateral parts of the anterior abdominal wall during hernia and to determine the possibilities of surgical correction of the identified changes.

   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.

   Results. The target structures (weak points) of the lateral parts of the anterior abdominal wall involved in the formation of hernias should be considered: paravertebral, subcostal and lateral fascial nodes (paired). Degenerative processes of fascial-muscular tissues in the area of hernial gates lead to a decrease in their biomechanical parameters compared to native drugs by more than two times, which leads to a relapse of the disease after hernioplasty. When performing hernioplasty in an original way, the tensile strength of tissues in the area of hernial defect plasty increases by 44,2 %, and the modulus of elasticity by 49,1 % compared to such indicators in a herniator.

   Conclusion. The proposed technique of strengthening the edges of the hernial gate with two frame threads when fixing the mesh graft increases the ability of tissues to withstand the increasing intra-abdominal pressure after surgery, which prevents the threat of relapse of the disease.

   Introduction. In order to improve the results of surgical treatment in patients with ventral hernias of lateral localization, an original technique of non-tensioning plastic surgery using frame threads and a polypropylene mesh graft has been developed. The results of the application of a new original hernioplasty technique are presented.

   Materials and methods of research. A retrospective analysis of the "hospital patient cards" of 63 patients was carried out. 2 groups of patients were formed. The "main" group included patients after hernioplasty using the original technique of non-tensioning hernioplasty – 29 patients, the "control" group consisted of 34 patients who underwent conventional non-tensioning hernioplasty. The basis of the original technique is the use of two frame threads in the preperitoneal space and above the muscles of the anterior abdominal wall, which are captured when applying U-shaped sutures that fix the mesh endoprosthesis.

   Treatment results. A comparative analysis of the long-term results of operations with an average follow-up period of 36,22 months showed that there was no recurrence of hernia in patients operated according to the original method, while out of 34 patients in the control group, 5 people (14,7 %) had a relapse.

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

   Introduction. With the increase in the number of advanced forms of cancer, the number of cytoreductive and palliative surgical interventions in oncological patients with tumors of the gastrointestinal tract has increased. The use of a single-row suture in the formation of anastomoses between the hollow organs of the abdominal cavity with accompanying therapy can reduce the time spent in hospital and accelerate early accelerated rehabilitation, improve the quality of life, reduce postoperative complications.

   Materials and methods. The analysis of surgical treatment of 60 palliative patients with gastric, colon cancer of the 1st stage, 1V clinical groups complicated by bleeding from a decaying tumor of the exit part of the stomach, right and left half of the colon was carried out. For the prevention of postoperative and infectious complications, purulent-septic complications, accompanying therapy was applied using a powerful topical antiseptic Anolyte neutral in the form of a solution.

   Results. Analysis of the results of the early postoperative period in the main group compared with the control group showed an improvement in intestinal peristalsis during auscultation, optimization of the appearance of an independent stool, rapid relief of pain syndrome along the suture.

   Introduction. Currently, there are a large number of methods and techniques for the surgical treatment of hemorrhoids. All of them have advantages and disadvantages. In our work, we have combined several of the most effective methods to create a combined method of radical treatment of hemorrhoids of any stage with the possibilities of an individual approach to the patient.

   Purpose of the study. To evaluate the results of the combined method of surgical treatment of hemorrhoids by the method of submucosal laser destruction in combination with uncontrolled doppler desarterization, mucopexy and electroexcision of the external component according to indications.

   Materials and methods. The study included 215 patients with stage 2, 3 and 4 hemorrhoids. All patients underwent submucosal laser destruction of internal hemorrhoids with Doppler-controlled desarterization, supplemented according to indications with mucopexy and electroexcision of the external hemorrhoidal component. Surgical treatment was performed under intravenous anesthesia with the addition of tumescent anesthesia. Laser radiation of a diode device with a wavelength of 1,56 μm was used, the power was 10 W.

   Results. The combined technique has no restrictions on the stage and severity of the disease, minimizes the risk of postoperative bleeding and purulent complications, ensures that there is no risk of developing postoperative stenosis or anal insufficiency, creates conditions for a high quality of life for the patient in the postoperative period and guarantees against recurrence of the disease.

   Conclusion. The technique has technical simplicity, the possibility of an individual approach to the patient, allows you to increase the effectiveness of surgical treatment of hemorrhoidal disease, regardless of the stage and severity of the process.

Introduction. The methods used to treat cysts, especially surgical, spleen, are currently characterized by insufficient effectiveness and safety.

The purpose of the study. Improve the results of surgical treatment of spleen cysts.

Materials and methods of research. Surgical treatment of 49 patients with spleen cysts was performed. They are divided into 2 groups: the first (n=23) – was carried out by standard methods; the second (n=26) – the proposed method was used in the treatment. In the main group, the method of treatment of spleen cysts proposed by us was used (resection of the free part of the cyst wall by laparoscopic access, sanitation of the cyst cavity, intersection of adhesions and the implementation of combined local exposure, including the use of electrothermically modified 3% polydocanol solution and performing tamponade of the cyst cavity). Research methods – clinical, including the determination of the severity of pain syndrome on a visual analog scale (VAS).

Treatment results. It was found that the developed method is characterized by better intraoperative than standard resection of spleen cysts (the duration of the proposed operation (67,3±8,5 min) and the volume of blood loss (135,8±19,3 ml) was lower than the standard (87,1±12,4 min and 192,3±24,2 ml)) indicators, lower severity of pain syndrome (pain in the main group was less than the comparison group on the 1st, 7th, 14th day by 33,7, 34,0 and 61,1 % (p<0,05) in the postoperative period and a significant decrease in the frequency of early complications. It also helps to reduce the duration of treatment of patients and is accompanied by a lower frequency of relapses and complications compared to the standard method.

Conclusion. The application of the developed approach to surgical treatment of spleen cysts is a clinically effective and safe method of treating this pathology.

   Introduction. The use of various implants in herniology dictates the need to study the quality of their integration. In this aspect, it is often impossible to perform morphological studies in patients.

   The purpose of the study. Assessment of reparative processes in the implant placement area depending on its material.

   Materials and methods of research. The study included 25 patients with inguinal hernia, all underwent laparoscopic hernioplasty. Titanium mesh implant was installed in 11 patients (group 1), polypropylene implant was installed in 14 patients (group 2). Ultrasound evaluation of the implant placement zone was performed 1–3 days, 2 weeks, 2, 6 and 12 months after surgery.

   Research results. 2 weeks after surgery, residual exudation in the implant placement area was detected in 35,7 % of group 2 patients. Patients of group 1 showed earlier germination of implant cells by connective tissue (2 weeks after surgery) than in group 2 patients (6 months later). 12 months after surgery, a thicker periimplantation scar was formed in patients of group 1 than in patients of group 2 (2,5 ± 0,2 mm vs. 1,25 ± 0,1 mm, at p < 0,05). During this period, 28,6 % of group 2 patients retained echo signs of ongoing reparative processes around the implant.

   Conclusion. The results obtained indicate the advantage of titanium mesh implants over polypropylene ones in the surgical treatment of patients with inguinal hernias.

   Introduction. The number of complications of surgical treatment of patients with phlegmon of the upper limb does not lose its relevance. The developed compartment syndrome against the background of a purulent-inflammatory process of the affected limb segment, left unattended, can lead to a permanent loss of limb function.

   Purpose of the study. To increase the effectiveness of surgical treatment of intermuscular phlegmon of the upper limb by analyzing the pathogenetic mechanisms, the results of decompressive fasciotomy in the structure of combined treatment.

   Materials and research methods. The clinical section of the work was performed on 134 patients with intermuscular phlegmon of the upper limb, who were treated in the department of purulent surgery of the MBUZ "GBSMP, Rostov-on-Don". The subjects were divided into 2 clinical groups. In both groups under study, surgical treatment of phlegmon of the shoulder and forearm was carried out according to known technologies. In 72 patients (the main study group), treatment was carried out taking into account the developed diagnostic and treatment algorithm, enshrined in Russian patents (№ 2755169, 2699964). In accordance with the algorithm, the tactics of treatment were determined. A morphological assessment of the state of the fascio-muscular structures of the upper limb was carried out on preparations from patients with different duration of the disease and the degree of tissue hypertension, which substantiate the expediency of performing the operation.

   Conclusion. The developed treatment algorithm made it possible to exclude unsatisfactory results of treatment by 100 %, to achieve good results in 91.7 % compared to 54,8 %, which indicates the importance of this complex of therapeutic measures.

   Introduction. Optimizing the treatment of pressure ulcers in patients in chronic critical condition due to cerebral catastrophe.

   Material and methods. The study included 48 patients of the above category treated with the use of high-frequency electrical stimulation (HPS) technology aged 28 to 74 years and the depth of damage of the II-III degree according to the classification Agency For Health Care Policy and Research (1992). For objective evaluation, the results were compared with those of 46 patients in the control group (conventional therapy), comparable in demographic and clinical criteria. Objective controls included bacteriological, cytological and morphological studies, as well as the Bates-Jensen scale.

   Results. High-frequency electrical stimulation contributed to a qualitative acceleration of reparative processes in pressure ulcers, a reduction in the total duration of treatment and rehabilitation. A comprehensive instrumental study confirmed a more pronounced positive dynamics of the complicated wound process against the background of periodic high-frequency electrical stimulation.

   Conclusion. The obtained results allow us to conclude that an integrated approach is promising in the treatment of decubital ulcer in patients in chronic critical condition due to severe brain damage. Stimulation of pressure sores by high-frequency electrical stimulation induces acceleration of regenerative processes in the pressure ulcer wound, reducing the period of inpatient treatment and the time for the start of further rehabilitation measures in persons of this clinical category.

   Introduction. The causes of pulmonary cavities are known and described by many clinicians and radiologists, but in the past two years, against the background of SARS-CoV-2 viral pneumonia, unusual cavities in the lungs have appeared, differing both in radiological manifestations and clinically.

   The purpose of the study. To present data on new, rare observations of the occurrence of lung cavitation in patients with Covid-19 and to determine the preferred treatment tactics.

   Materials and methods. A study of the results of treatment of 9924 patients with Covid-19, aged 18 to 104 years, among whom 36 cases of lung cavitation were detected (20 women and 16 men). We note that cavitations can complicate the course of coronavirus infection, especially with subpleural localization.

   Results. Of the 36 patients with covid cavitation, 4 died, which was 11,1 %, with a total mortality of 10 %. Long-term results were obtained, after cavitation, only in 5 patients out of 32 discharged, in the interval from 2 to 3 months: in 3 of them, multiple fibrous foci were detected during the control CT scan, in 2 – thin-walled "dry" cavities of small size.

   Conclusion. Pulmonary cavitations at Covid-19 don't represent a serious problem, however they should be meant how the obvious causes of pheumothorax, a pnevmomediastinum and a piopnevmotoraks and also possible sources of pulmonary bleeding.

   Introduction. The purpose of the study: to analyze the results of surgical treatment of patients with pathological fractures of the vertebral bodies and to improve the quality of life.

   Materials and methods. 100 patients with pathological fractures of the vertebral bodies of the thoracic and lumbar spine were operated on. 50 people (main group) – anterior access using individual metal–polymer and polymer endoprosthetics of vertebral bodies, 50 people (control group) – posterior access with transpedicular fixation and posterior instrumental fixation with a laminar system of the SD type. In the main group, accompanying therapy with the use of adaptogen (Adaptol) and the original antiseptic Anolyte neutral (ANC) was used. And in the control group, accompanying therapy was not used.

   Results. The results obtained indicate the effectiveness of surgical treatment of pathological fractures by anterior approach with the use of accompanying
therapy, which improves the quality of life, reduces the number of infectious postoperative complications and hospital stay.

   Conclusion. The advantages of anterior access are a significantly favorable exposure of the surgical wound, which makes it easy to remove a vertebral tumor within healthy tissues, cope with bleeding, prevent blood loss, and reduce the time of surgical intervention. The use of accompanying therapy makes it possible to exclude postoperative infectious complications.

   Introduction. For the correct staging of stomach cancer, high-quality and reliable visualization is important, including using radiation diagnostic methods. Most often, information about the stage of the disease and the morphological type of the tumor can be obtained only by pathoanatomic examination after a surgical operation. Therefore, the study of the possibilities of radiation diagnostic methods, in particular, computed tomography (CT), has great potential for determining treatment tactics.

   The purpose of the work. To show the possibility and evaluate the prospects of 3D reconstruction of the mesogastric layer in locally advanced cancer of the cardio-esophageal junction.

   Materials and methods. The MSCT of a patient with locally advanced cancer of the cardio-esophageal junction was analyzed, with an assessment of the densitometric density of the surrounding perigastric fiber, affected and  healthy lymph nodes. Based on this, a 3D model of the stomach with altered perigastric fiber was constructed, an attempt was made to assess the degree of "interest" of the mesogastric layer in order to provide surgeons with a visual picture of the volume of the upcoming operation. These data were compared with the intraoperative picture (including ICG marking) and the results of histological examination.

   Results. In the area of the removed mesogastric layer, the density of which according to computed tomography was higher than the rest, free tumor deposits were found and areas of lymphovascular tumor invasion, as well as metastatic lymph nodes, were described.

   Introduction. Сholelithiasis is the most frequent cause of surgical interventions worldwide. However, a complication of this multifaceted nosology in the form of biliary ileus is relatively rare. The frequency of recurrent, so called "staged" biliary intestinal obstruction is even lower: there are almost no reports of such cases in the literature. This article presents a rare case of recurrent small intestinal biliary obstruction in the early postoperative period, which required two surgical interventions during a single hospital stay.

   Materials and methods of research. A medical history of a patient treated in the surgical department of Municipal Clinical Hospital № 31 in April 2022.

   Treatment results. The patient was discharged in a satisfactory condition on the 10^th day after repeated surgery.

   Conclusion. The recurrence of biliary intestinal obstruction is an extremely rare and difficult to detect complication, but one that nevertheless deserves attention. It should be suspected in patients who have undergone surgery for cholelithiasis if they have a clinical picture of intestinal paresis in the post-operative period. In such a case an urgent abdominal ultrasound and dynamic overview radiography should be performed to rule out a possible recurrence.

   Introduction. The article describes a clinical case demonstrating the difficulties of diagnosis and aspects of surgical treatment of diverticular disease complicated by the formation of a colovesical fistula.

   Discussion. A colovesical fistula is formed due to the destruction of the diverticulum wall due to chronic inflammation and the formation of a junction with a neighboring organ or the environment. Most often, colovesical fistulas are a consequence of a complicated course of diverticular disease, but the causes may also be inflammatory diseases of the colon, as well as tumor diseases of the intestine or urinary system. During the diagnosis and choice of treatment tactics for patients with diverticular disease complicated by the formation of a colovesical fistula, the participation of doctors of different specialties is necessary: coloproctologists, surgeons, urologists and oncologists. Without radical treatment, the risk of relapse is extremely
high. In this regard, timely diagnosis, a multidisciplinary approach and an adequate amount of surgical intervention are the key to successful treatment of patients with colovesical fistulas.

   Conclusion. Surgical intervention in complicated forms of diverticular disease is the only possible option for radical treatment, while the choice of access and scope of intervention should be determined individually in each case and take into account the prevalence of the process, anatomical features and experience of the surgeon.

   Introduction. A phylloid tumor, also known as a leaf–shaped or intracanalicular fibroadenoma with a cellular stroma is a rare pathology that accounts for 0.3–0.5 % of all breast neoplasms. A phylloid tumor is characterized by the potential for transformation into a breast sarcoma due to malignant changes in the stroma. Breast sarcoma is a rare non–epithelial malignant tumor that occurs in 1 % of cases of the total number of malignant breast tumors and 5% of all soft tissue sarcomas. Primary breast sarcomas are rare and histologically heterogeneous malignant neoplasms, publications on this topic are limited.

   Description of the clinical case. The article presents a clinical observation of a patient with a malignant phylloid breast tumor who underwent surgical treatment in the volume of a radical mastectomy according to Madden.

   Discussion. The clinical case is interesting for the rare type of fibroepithelial tumor and the difficulty of final verification of histogenesis at the preoperative stage due to the difficulty of differentiating malignant leaf-shaped tumor from metaplastic carcinoma.

   Conclusions. Specialists will have to conduct a considerable number of histochemical and genetic studies of a large number of cases of malignant phylloid breast tumors to develop an effective algorithm for the treatment of this pathology.

   Introduction. Among patients with complicated ulcers, in 25–50% of cases there are chronic duodenal obstruction (CDO), on the other hand, the resection of the stomach itself is the cause of the disruption of the normal function of the duodenal sphincter. Data on the frequency of duodenogastric reflux in peptic ulcer and after gastric resections are very contradictory.

   Purpose – to present modern views on the pathogenesis and treatment of alkaline reflux gastritis that develops after gastric resection.

   Material and methods. Literature search was carried out in the following electronic databases: Paragraph Medicine, Web of Knowledge (ThomsonReuters), Scopus, Pubmed Medline, The Сocrane Library, Springer Link, Ebscohost Science Direct. The search period was from 2003 to 2020 (with the exception of 5 sources:). More than 250 sources have been analyzed. The review includes 40 articles on the specified topic, which were available in full text and analyzed by critical evaluation.

   Results. Summarizing the literature review, we can say that there are no significant reductions in the number of post-gastroresection complications, including duodeno-gastric reflux (DGR). One of the methods for the prevention of DGR is the detection of CDO in the preoperative period. The only variant of gastroenteroanastomosis that can prevent enterogastric bile reflux is a Roux-loop anastomosis.

   Conclusions. These patients should be operated on in clinics where surgeons are impeccably proficient in various types of operations on the esophagus, stomach and duodenum. Literature data suggest that in the majority of patients with excessive enterogastric reflux, transformation into a long loop of Roux-en-Y leads to a stable symptomatic effect for at least 3 years.