In recent years, the technology of vacuum-assisted laparostomy has become widespread in patients with peritonitis. Despite the high efficacy of using negative pressure in an open abdomen in patients with peritonitis, data on safety and efficacy have so far been limited. The introduction of a vacuum-assisted laparostomy evaluates an increase in the effectiveness of the results; however, the lack of standardization of this technology is an important drawback in assessing its effectiveness and safety. At the same time, research results published.

Study purpose. Systematization and analysis of current information substantiating the use of vacuum-assisted laparostomy in patients with peritonitis, identifying unresolved issues, identifying ways to prevent complications and standardize the technology.

The variety of negative pressure systems and the lack of a standardized algorithm for managing an open abdomen with negative pressure therapy in peritonitis are an important limitation in evaluating the efficacy and safety of this technology. The study of immediate outcomes and optimization of the technology of vacuum-assisted laparostomy in the treatment of peritonitis seems to be an urgent and important research task.

Introduction. In colorectal cancer surgery, high ligation of the inferior mesenteric artery (IMA) is the "gold" standard. Low ligation of the IMA can decrease the frequency of anastomotic leakage.

Aim: to study the variant anatomy of the IMA and determine its significance when choosing the level of ligation.

Materials and methods. The research is based on the PubMed and eLIBRARY articles, 30 of which are included in the final review and analysis.

Results. In practice, the classification of Yada-Murono is of the greatest interest, according to which there are 4 types of the IMA anatomy: type I – left colic artery (LCA) emanates from IMA independently; type II – LCA and sigmoid artery (SA) co-trunk; type III – LCA, SA and superior rectal artery (SRA) emanate from the same point; type IV – LCA is absent.

Discussion. Preservation of the LCA in patients with type I does not cause difficulties for the surgeon. With type II, low ligation due to a short IMA can cause tension of the anastomosis area and the development of anastomotic leakage. For patients with type III, preserving LCA is necessary because high ligation is accompanied by hypoperfusion and more frequent anastomotic leakages. For patients with type IV, the search for LCA is associated with the risk of damaging neighboring structures.

Conclusion. Assessment of the IMA anatomy and its branches is of practical importance in colorectal cancer surgery in order to choose the optimal level of its ligation.

Introduction. Objective of the study. This study aims to analyze clinical and objective methods of diagnosing delayed gastric emptying following pancreaticoduodenectomy.

Materials and methods. Within the scope of this review, we analyzed scientific publications and studies related to the problem of diagnosing delayed gastric emptying. Clinical, laboratory, and instrumental diagnostic methods were considered, including: unified gastroparesis criteria according to ISGPS classification, Gastroparesis Cardinal Symptom Index (GCSI), caprylic acid breath test, acetaminophen absorption test, gastric radiography, ultrasound, magnetic resonance imaging, electrogastrography, examination using a video capsule (SmartPill), and scintigraphic method.

Results. Based on the analyzed data, it was established that the majority of available methods for diagnosing delayed gastric emptying have certain limitations and do not provide a complete and objective evaluation of gastric motility. The scintigraphic method, recognized as the gold standard, has the highest sensitivity and specificity, as it provides a physiological, non-invasive, and quantitative assessment of gastric evacuation in the postoperative period.

Conclusions. Various methods for diagnosing delayed gastric emptying provide an opportunity to assess disruptions in the motor-evacuatory function of the stomach and to detect the presence of gastroparesis. Scintigraphic examination is the most informative method, providing an objective assessment of the function of gastrojejunostomy and choledochojejunostomy.

The paper presents the main years of the life and scientific work of the prominent Russian surgeon and scientist-innovator Professor A.E. Rauer. The article analyzes the fact that from 1922 to the end of life Alexander Eduardovich headed the maxillofacial department of the Central Institute of Traumatology and Orthopedics (CITO). Since 1932, Professor A.E. Rauer was the head of the Department of Maxillofacial Surgery of the CIU, organized by him on the basis of the maxillofacial department of the CITO (Moscow). He summarized all his rich experience in his final work "Plastic Surgery on the face", awarded in 1946 The Stalin Prize. His main works were devoted to the problems of maxillofacial surgery. Rauer proposed a number of valuable ways to eliminate facial disfigurement, which have become widespread (for example, oblique osteotomy for ankylosis of the jaws, surgery for habitual dislocations, plastic surgery of through facial defects, etc.). Under the leadership of Alexander Eduardovich, the clinic also developed methods of plastic surgery for fan-shaped neck scars after thermal injuries and restoration of the pharyngeal arches with soft palate defects. It is noted that he worked a lot on plastic surgery of other organs and proposed methods of interventions for congenital malformations of the bladder, limbs, etc. During the Great Patriotic War, A.E. Rauer introduced into practice a method of treating granulating surface wounds by forming secondary plate ligatures. It is shown that after him there were many worthy students who continued his work on the further development of maxillofacial surgery, which has become an important and necessary branch of clinical medicine.

Introduction. The use of supracosteal access when performing ITP provides the easiest access to the upper calyx and is recommended in the presence of complex kidney stones.

Purpose of the study. Identification of the safest and most effective approach to the implementation of PTDTs and determination of indications for unpaired PTDTs. Materials and methods of research. A retrospective analysis of the case histories of 56 patients who underwent supra-rib PNLT in the urological department of ChUZ "KB" RZD-Meditsina "in Krasnoyarsk from January 2018 to December 2022 was carried out. Drainage-free PNLT was performed in 42 patients out of 56 (75 %). In all cases, supracosteal access was performed, and in 20 patients, a second working channel was additionally formed in a standard position below the XII rib.

Treatment results. We evaluated the efficacy of PNLT for two groups of patients: the supracostal group without nephrostomy and the supracostal group with established nephrostomic drainage at the end of operative treatment. The results showed that the SFR for the supracostal group without nephrostomy was 90 %, while in the supracotsal group with external drainage this figure was 64 % (p < 0,05). The overall SFR in the study was 83,9 %. The overall complication rate was 12,5 %, with infectious-inflammatory complications most often occurring, which were managed conservatively.

Conclusion. Supra-rib LAFT can be a safe and effective procedure with careful anatomical positioning, adequate puncture of the renal cavity system and an experienced operator.

Introduction. Colon cancer occupies one of the leading positions in the structure of oncological morbidity. One of the most severe and sometimes life-threatening complications of sphincter-sparing operations is the failure of the colorectal anastomosis, which occurs in 13 to 30 % of cases, and the associated postoperative mortality reaches 6.0-39.3 %.

The aim of the study. Improved results of surgical treatment of rectal cancer due to reduced number of cases of colorectal anastamosis failure by using in clinical practice modified method of formation of laparoscopic intracorporeal mechanical colorectal anastomosis.

Material and methods. The study included 80 patients: group I - 46 (57.5 %) patients who underwent laparoscopic anterior resection of the rectum in the conventional way; Group II included 34 patients (42.5 %) who were operated on according to the developed technique for the formation of intracorporeal colorectal anastomosis.

Results. In group I, in 4 cases, radiological failure of the anastomosis was established in the presence of a preventive stoma, in 3 patients a clinically significant failure was noted, requiring repeated intervention. Localization of suture failure in 85.7 % of cases developed in the blind pocket (“dog ears”). In group II, 2 patients with incompetence were identified, who were treated conservatively.

Conclusions. The advantage of the original method of applying colorectal anastomosis is the ability to adapt the walls of the sutured sections of the intestine even with repeated stitching of the intestinal stump with a linear apparatus.

Introduction. Metastatic bone tumors (myelocarcinosis) of epithelial origin in cancers of various localization occur in thirty percent. The appearance of micrometastases in the bones, their growth often outstrips the formation of the primary tumor and leads to pathological fractures. The use of modern complex treatment for multiple bone metastases leads to a slowdown in tumor growth and the complete disappearance of bone metastases.

Materials and methods. To confirm the effectiveness of the developed scheme for the prevention of postoperative infectious complications in simultaneous surgical treatment of lung cancer, stomach cancer, colorectal cancer in patients over 60 years of age with myelocarcinosis, the results of treatment in 60 elderly and senile patients who underwent simultaneous operations 2017–2022 were studied. The patients were divided into 2 groups – the main and control.

Results. It was possible to significantly reduce the frequency of postoperative complications in the main group compared to the control group, the frequency of purulent complications decreased and mortality decreased by 9,55 % compared to the control group.

Conclusions. The effectiveness of simultaneous operations in elderly and senile patients has significantly improved as a result of the use of original, domestic accompanying therapy.

Introduction. Currently, there are a significant number of techniques and methods of surgical treatment of pilonidal coccyx cyst in surgical practice.

The purpose of the study: to evaluate a new surgical method of treatment, to evaluate the improvement of the results of treatment of patients with pilonidal coccyx cyst using the modernized technique.

Materials and methods. In our work, we applied the most modernized and radical surgical method of treating patients with PKK, compared two groups of patients. The main group consisted of 33 patients with PKK who received standard treatment. The comparison group included 31 patients who underwent the author's treatment. The results were evaluated in the long-term period.

Results. In the comparison group, according to the results of the study with the main group, there was a statistically significant decrease in pain syndrome in the postoperative period, a decrease in bed days, as well as a significant decrease in long-term postoperative complications (p<0.05).

Conclusion. To exclude the occurrence of a relapse of PKK, it is possible to recommend performing the operation according to the guaranteed and radical method we propose.

A new surgical method for the prevention and treatment of the formation of rough postoperative keloid scars of the interstitial furrow, improves the quality of life and reduces the risk of relapse for patients with PKK.

Introduction. Questions of morphological changes in phlegmon of the upper limb, occurring in the anatomical formations against the background of the compartment syndrome, remain insufficiently disclosed.

Purpose of the study. To study the effect of increased tissue pressure (compartment syndrome) on fascio-muscular structures in the area of development of phlegmon of the upper limb and to substantiate the expediency of decompressive fasciotomy.

Materials and methods. The study included 134 patients with deep intermuscular phlegmon of the upper limb, who were treated in the period from 2016 to 2022 in the conditions of the department of purulent surgery of the GBU RO "GBSMP" in Rostov-on-Don. Group I (comparison) included 62 patients, group II (study) included 72 people. Treatment of patients of group I was carried out according to known technologies. In group II, patients were treated according to original methods protected by patents of the Russian Federation. 3 subgroups were formed according to the severity of the course of the pathological process.

Treatment results. The conducted morphological study through the use allowed us to establish statistically significant differences in morphological changes depending on the severity (which was dependent on the tissue pressure index).

Conclusions. In patients with intermuscular phlegmon of the upper limb, tissue pressure should be monitored. With an increase in tissue pressure by 10–20 mm Hg. from the physiological norm, decompressive fasciotomy prevents the development of non-standard morphological changes in muscle tissue, especially in grades II and III of the course of the pathological process (at grade III, this process slows down).

Introduction. For many years the treatment of patients with true splenic artery aneurysms remained the prerogative of cardiovascular surgeons, but the development of minimally invasive surgical techniques has made it possible for hepatopancreatobiliary surgeons.

Materials and methods of research. We analyzed the results of treatment of 31 patients diagnosed with true splenic artery aneurysm who underwent surgical intervention in the surgical clinic of Botkin Hospital from 2020 to 2022. Laparoscopic clipping of aneurysm branches was performed in 29 (93,5 %) cases, in 1 (3,2 %) – laparoscopic splenectomy because of combined echinococcal affection of the spleen, one open clipping was done because of the simultaneous hepaticojejunoanastomosis formation. Evolution of surgical accesses was traced in the work as well as the analysis of immediate results of surgical interventions, general and specific postoperative complications according to Clavien-Dindo classification, and distant results were carried out.

Results. We analyzed 29 case histories of patients with true splenic artery aneurysms who underwent laparoscopic intervention. The surgical intervention time was 122,75 (60–240) minutes. Postoperative bed-day was 4,4 (2–8). Postoperative complications were revealed in two patients: in one case (3,2 %) we detected the development of acute posttraumatic pancreatitis, in the second – clinically significant spleen ischemia. Long-term results were traced in 19 patients, no recurrences of aneurysms as well as their recanalization were revealed in any case.

Conclusion. The modern approach to the treatment of true splenic artery aneurysms using laparoscopic techniques allows safe treatment of such patients with good long-term results.

Introduction. Chronic pelvic pain (СPP) is chronic or persistent pain perceived in structures related to the pelvis of men and women.

CPP is often associated with compression of the left common iliac vein (CIV) by the right common iliac artery, i.e. May-Turner syndrome (MTS). MTS treatment consists in surgical elimination of vein compression by the endovascular method - stenting of the left CIV.

Purpose of the study. Evaluation of the clinical effect after stenting of the left OPV in STS

Materials and methods. We performed 27 stentings of the left iliac veins for MTS. 27 (100 %) complained of chronic pain in the pelvic area of varying degrees of intensity (4-8 points on the VAS scale). Assessment of the clinical status of the operated patients, as well as ultrasound of the veins of the lower extremities and small pelvis, was performed on the 30th day after discharge from the hospital and 6 months later at the control visit.

Research results and discussion. The technical success of stenting was achieved in 100 % of patients. All stents were patent by ultrasound. No adverse events were observed in this group of patients during the 30-day period.

The subjective assessment of the degree of regression of primary complaints, according to the questionnaire, was 48.3 %. Patients noted an improvement in the quality of life, a persistent reduction in pain.

Further analysis showed that within 90-180 days after surgery, the degree of regression of primary complaints approaches 86.3%.

Conclusion. Stenting of the left CIV, elimination of compression and improvement of venous outflow from the pelvic organs, within 90-180 days after surgical treatment, leads to the desired clinical effect with the relief of chronic pelvic pain or a persistent decrease in the degree of pain syndrome (the degree of regression of primary complaints is 86.3 %).

Introduction. Liposarcoma is the most common mesenchymal tumor, in 10–15 % of cases located in the retroperitoneal space. Diagnosis of liposarcomas can be difficult because of the lack of obvious symptoms for a long time, that is why neoplasms can reach huge sizes. Operated giant liposarcomas are dangerous for the occurrence of relapse in the future.

Materials and methods. A 74-year-old patient was hospitalized with complaints of abdominal enlargement, which caused a progressive decline in the quality of life. Operation and histological examination were performed more than 10 years ago, a diagnosis was made – retroperitoneal lipoma.

We carried out a rational and maximally safe resection of the neoplasm. According to the results of histological examination, considering the size, location and anamnesis, the neoplastic process should be regarded as a highly differentiated liposarcoma.

Discussion. Planning an operation for giant liposarcomas, especially relapses, it is necessary to take into consideration the risk of possible bleeding and somatic complications, and to carry out the operation in the maximum possible, but safe amount. Proper planning of surgical intervention is necessary to perform a saving operation without organ resections and vascular prosthetics. Primary qualitative histological examination is very important for monitoring the dynamics and prompt diagnosis of relapse.

Introduction. Objective. The feasibility of prophylactic myocardial revascularization in planning non-cardiac surgical interventions remains as a subject of debate today.

Purpose of the study. To compare the immediate and long-term results of surgical treatment of patients with lung cancer with concomitant CAD, when prophylactic myocardial revascularization was performed, with operated patients with lung cancer without CAD.

Materials and methods. The study included 134 patients operated on for lung cancer, 126 (94,0 %) men and 8 (6,1 %) women, the mean age was 63,9 years (from 36 to 81). Of these, the main group: 63 (47 %) patients with concomitant CAD, when prophylactic myocardial revascularization was performed, and the control group: 71 (53 %) patients without concomitant CAD (or who does not need prophylactic revascularization).

Results: the incidence of postoperative complications in the main and control groups was 33,3 % (21/63) and 25,4 % (18/71) (p=0,453), and mortality was 1,6 % (1/63) and 4,2 % (3/71) (p=0,385), respectively. Perioperative myocardial infarction in the main group was registered in 3,2 % (2/63) with a fatal outcome in 1,6% (1/63), and in the control group it was 0 % (0/71) (p=0,137; p=0,291).

The overall 1-, 3-, and 5-year survival of radically operated patients in the main group was 81,7%; 67,6%; 50,0%, and in the control group – 86,8 %, 62,5 %, 53,8 % (p=0,750), respectively.

Conclusions. Prophylactic myocardial revascularization in patients with lung cancer allowed achieving comparable immediate and long-term results of surgical treatment of patients with lung cancer with concomitant coronary artery disease and without it.