Introduction. Purpose of the study. To conduct a comparative analysis of external and external-internal biliary drainage for distal malignant biliary obstruction (DMBO).

Research methods. At the Botkin Hospital (Moscow) from 2015 to 2019. We conducted a retrospective analysis of the treatment of patients with PADD, the cause of which was ductal adenocarcinoma of the head of the pancreas. The patients were divided into two groups: G1 – external biliary drainage was performed (n=76), G2 – external-internal biliary drainage (n=94). Characteristics of the groups: age G1 62,3±4,3, G2 63,5±3,9 (p=0,057); gender (m/f) G1 37/41, G2 39/55 (p=0,245); ECOG G1 1,3±0,3, G2 1,4±0,2 (p=0,081); total bilirubin G1 236,2±35,2, G2 228,7±28,5 (p=0,132); alkaline phosphatase G1 658±31,1, G2 649±25,8 (p=0,093); AST G1 216±10,3, G2 213±12,5 (0,086); ALT G1 319±12,2, G2 322±11,5 (p=0,101).

Results. When comparing immediate results, a statistically lower number of Clavien-Dindo complications was revealed in patients with external-internal bile diversion (22,3 % versus 37,2 % (p = 0,043). A qualitative analysis of complications revealed that cholangitis (6,4 %, versus 18,1 %) and post-manipulation pancreatitis (2,6 %, versus 19,1 %) were more common in the group with external-internal bile diversion with statistical significance of the differences (p =0,024 and p=0,001, respectively). Liver failure (26,9 %, versus 13,8 %) and cholangiostomy dislocation (12,8 %, versus 4,2 %) developed more often in the group of patients with external biliary decompression (p=0,036 and p=0,041, respectively). Complications such as biliary peritonitis (6,4 % versus 7,4 %) and acute cholecystitis (5,1 % versus 5,3 %) occurred in both groups without significant differences (p=0,791 and p=0,955, respectively).

Conclusion. External-internal bile diversion is the preferred procedure for DMBO. External bile diversion should be performed according to individual indications.

Introduction. At all times, beautiful appearance has been of great importance for self-satisfaction, especially for representatives of the weaker half of humanity. Currently, plastic surgery is rapidly gaining momentum, the demand for plastic surgery is increasing every year. Today, abdominoplasty has firmly taken its place in plastic surgery and firmly occupies 7–8 place among all plastic surgeries performed. The purpose of the work is to substantiate the expediency of using certain methods of abdominoplasty using clinical examples.

Materials and methods. Indications for classical abdominoplasty, supplemented by aponeurosis plastic surgery, lipoaspiration and navel transposition, are considered on the example of three patients.

Results and discussion. All three patients underwent classical abdominoplasty, supplemented by lipoaspiration, strengthening of anterior abdominal wall aponeurosis and navel transposition. Elimination of diastasis of the rectus abdominis muscles was carried out by implication of the vaginas of the rectus abdominis muscles. Synthetic materials (mesh) were not used.

Conclusion. Despite the sufficient period of existence of the abdominoplasty operation, the issues of applying one or another method of performing surgical treatment are still being debated. It is necessary to study and compare the results of various methods of abdominoplasty and develop common indications for the use of each of the techniques.

Introduction. Malrotation syndrome is exceptionally rare in the adult population, predominantly manifesting clinically in infants within the first month of life. The most common form of malrotation is Ladd's syndrome, with occasional delayed presentations into adulthood. Consequently, diagnosing and timely surgically treating such patients pose a complex challenge. In instances of delayed diagnosis and treatment, there is a significantly elevated risk of developing strangulated intestinal obstruction or intestinal infarction, leading to potentially lethal complications.

Description. This article presents a clinical case of a 50-year-old female with Ladd's syndrome admitted to the surgical ward in a state of complications, presenting as acute strangulated intestinal obstruction. The article outlines the management approach taken in this clinical scenario, detailing a successful two-stage surgical intervention. The first stage involved emergency resection of the pathological segment of the small intestine and the distal portion of the cecum, with the creation of an ileostomy and transverse colostomy. The second stage, planned four months later, encompassed a reconstructive-restorative operation aimed at restoring the integrity of the intestinal passage.

Results. Systematic collection of complaints, disease history, accurate interpretation of pre-hospital and in-hospital laboratory and instrumental study results facilitated a correct diagnosis and the implementation of an effective surgical intervention. The patient exhibited favorable clinical outcomes in the remote postoperative period.

Introduction. The article presents the results of observation of the postoperative period of surgical treatment of patients with inguinal hernias using tension-free hernioplasty using implants and autologous tissue flaps.

Aim of research. Reducing the number of complications in the postoperative period in patients with inguinal hernias, developing a hernioplasty method with less dependence on the availability of consumables.

Materials and methods of research. 759 patients with inguinal hernias. Place of study: State Budgetary Institution RO "City Clinical Hospital No. 11" and State Budgetary Institution RO "Ryazan Regional Clinical Hospital". Study period: hernioplasties were performed from 2006 to 2021, the duration of observation of the postoperative period of each patient was 1 year. Patient selection criteria: male gender, the presence of an inguinal hernia, age over 18 years, a herniotomy operation performed using the Desard method as modified by the authors, the peculiarity of which is the formation of a flap from the aponeurosis of the external oblique muscle, covering the spermatic cord, with fixation of its free end to the inguinal ligament (n=39) – main group, Bassini method (n=454), Lichtenstein method (n=266) – control group (n=720) in planned or emergency, informed consent signed by the patient for the operation and participation in the study.

Treatment results. In the main group, the postoperative period was characterized by a decrease in the number of complications in comparison with the group of planned and emergency patients operated on according to Lichtenstein, and was comparable in comparison with the group of patients operated on according to Bassini.

Conclusion. Based on the results of our research, we can conclude that the use of the Desard method, as modified by the authors, reduced the number of complications in the postoperative period in planned and emergency patients with inguinal hernias; a hernioplasty method with less dependence on the availability of consumables was proposed.

Introduction. Laparoscopic surgery is increasingly being used in various combined diseases, including in patients with chronic kidney disease on peritoneal dialysis. One of the absolute contraindications to the preparation and further treatment with outpatient peritoneal dialysis is the presence of a surgical history, as well as a diagnosed oncological process of the abdominal organs. Previously, the need for surgical intervention for colorectal cancer provided for the irrevocable completion of peritoneal dialysis in the treatment of a patient with CKD and transfer to programmatic hemodialysis.

The purpose of the study. Preservation of programmatic peritoneal dialysis in patients with terminal chronic renal failure after laparoscopic hemicolectomy with lymph node dissection for colon cancer.

Materials and methods. The search for keywords of literary sources in the international abstract database was carried out PubMed.gov , as well as the Russian RSCI system for the last 20 years with subsequent analysis. 2 patients with dialysis-related stage 5 chronic disease and colon adenocarcinomas are presented. Both patients underwent radical surgical treatment for a colon tumor while maintaining programmatic peritoneal dialysis.

Discussion. These clinical observations demonstrate that laparoscopic hemicolectomy on the left can be performed safely, providing the patient with the benefits of a minimally invasive approach and keeping it on PD. Our proposed surgical technique is a promising alternative for this group of patients, which makes it possible to continue treatment with peritoneal dialysis in the postoperative period.

Conclusions. A multidisciplinary approach combining modern laparoscopic operations, compliance with oncological principles and balanced nephrological tactics can represent a reasonable, safe strategy for surgical treatment of operable forms of colon cancer with the possibility of maintaining PD in the postoperative period.

Introduction. Purpose of clinical observation is to show expediency of evaluating parameters of pancreatic perfusion in patients with acute biliary pancreatitis according to computed tomography on first day of disease and stenting of pancreatic duct with insertion of tip of stent beyond hypoperfusion zone after eliminating cause of impaired bile outflow from common bile duct.

Clinical observation. Patient was admitted 10 hours after appearance of complaints, ultrasound revealed calculous cholecystitis, signs of biliary hypertension, an increase in bilirubin, transaminases, and amylase activity (2115 U/l). CT showed hypoperfusion in neck of pancreas with fluid-infiltrative changes in retroperitoneal tissue. EPST, lithoextraction, and stenting of pancreatic duct were urgently performed. Then, there was decrease in level of bilirubin, transaminases, and amylase to reference values. Laparoscopic cholecystectomy was performed on 8 day. Course of postoperative period is without complications. He was discharged in satisfactory condition on 10th day of hospitalization. Stent was removed after 1 month.

Conclusion. CT data allowed not only to confirm diagnosis of choledocholithiasis with development of biliary hypertension, but also to obtain important information about hypoperfusion of parenchyma, mainly neck of pancreas, and formation of parapancreatitis already on 1st day of disease. Timely EPST performed with elimination of bile outflow block and stenting of pancreatic duct with a stent beyond hypoperfusion zone contributed to rapid relief of jaundice, cytolysis and acute pancreatitis with regression of local manifestations. This made it possible to perform cholecystectomy during the same hospitalization and prevented the likelihood of complications observed with delayed removal of gallbladder.

Introduction. Extensive distal coronary artery calcinosis (CAC) limits myocardial revascularization and is associated with suboptimal outcomes of surgical treatment. Coronary artery bypass grafting (CABG) for CAC requires the use of complex coronary reconstructions (CCR), including coronary endarterectomy (CEE), prolonged angioplasty and anastomoses with arteries less than 1.5 mm. Worldwide data on long term outcomes after CABG in patients with CAC are limited. The purpose of the study. To analyze and compare long term outcomes after CABG in patients with and without distal CAC

Materials and methods of research. A single-center retrospective study was performed, including 610 patients who underwent isolated CABG in the period from 2017-2019, of which 121 patients had CCA confirmed by computed tomography (CT), the rest – without CCA. After propensity score matching 115 pairs of patients were matched. Long-term outcomes were analyzed; the following events were studied as an end point: recurrence of angina and death. Median follow-up was 56 months (51, 62).

Treatment results. The majority of patients were male (68,0 % vs. 67,6%, p=0,953), mean age was 66,1±8,6 and 65,7±7,9 years for the groups, respectively, p=0,708. The revascularization index was higher in group 1 (4,0±0,8 versus 3,7±0,7, p=0,002. In the CCA group, significantly more CCR was performed (43,3 % versus 24,5 %, p=0,005). The time of cardiopulmonary bypass (CPB) was also higher in the group with CCA (93,9±25,9 minutes versus 82,9±18,7 minutes, p=0,002). In the long-term period, the rate of angina recurrence was 27,8 % in the CCA group and 22,5 % in the group without CCA (p=0,280), mortality – 6,2 % versus 2,9 % (p=0,322)

Conclusion. Extensive distal CCA is characterized by a higher frequency of CCR and duration of surgical treatment. CABG can be performed with complete myocardial revascularization and similar effectiveness in patients with and without CCA.

Introduction. The results of vascular reconstructions in atherosclerotic occlusion of the femoral-popliteal-tibial segment depend on the patency of the distal bed, and in particular on the state of the microcirculatory bed.

The purpose of the study. To study the possibilities of modern computer capillaroscopy as an additional method for determining indications for reconstructive surgery in patients with obliterating atherosclerosis of the arteries of the lower extremities with lesions of the femoral-popliteal-tibial segment.

Materials and methods of research. An attempt was made to study the microcirculatory bed in 156 people with obliterating atherosclerosis of the arteries of the lower extremities of the femoral-popliteal-tibial segment with stage III-IV according to the Fontaine-Pokrovsky classification. With the help of computer capillaroscopy, the indicators of capillary functioning were determined in patients who had effective reconstructive surgery.

Results and discussion. If, according to computer capillaroscopy, the number of linear working capillaries is 5,5 ± 2,4 pcs. per 1 mm2, and the number of working capillaries by area is 16,7 ±5,3 pcs. per 1 mm2, then it is possible to predict with a fairly high probability the preservation of the patency of the shunt a year after surgery. If the number of linear working capillaries is 3,3 ± 1,3 pcs. per 1 mm2, and the number of working capillaries by area is 5,7 ± 2,8 pcs. Per 1 mm2, then this indicates an initially unsatisfactory condition of the microcirculatory bed and a high probability that it may not cope with the increased load after surgery.

Conclusion. Computer capillaroscopy is a modern method of assessing the state of the microcirculatory bed of the lower limb, which allows you to determine the degree of its compensatory capabilities after reconstructive surgery.

Introduction. Gastric cancer commonly develops in elderly comorbid patients with nutritional impairments, with all those factors leading to the development of cachexia and/or sarcopenia.

The purpose of the study. To evaluate the prevalence of cachexia and sarcopenia in patients with gastric cancer and their correlation with complications of the treatment.

Materials and methods of research. We conducted a retro-prospective study including 225 patients: mean age was 66,3±10,5 years. Group 1 included 116 patients who got chemotherapy, Group 2 included 109 patients undergoing gastrectomy. Sarcopenia was defined according to pre-specified cut-offs based on semi-automated CT scan calculation of skeletal muscle at the L3 level. CT scans were obtained not more than 30 days before the beginning of the treatment.

Results. Cachexia was encountered in 75,9 % of patients. Sarcopenia according to Prado cut-offs was found in 76,8 % male and 56,3 % female, according to Martin cut-offs in 60,8 % male and 68,9 % female and according to EWGSOP2 criteria in 30,4 % male and 28,7 % female patients. Sarcopenic obesity was diagnosed in 6,2 % patients. We found a positive correlation between the presence of sarcopenia and asthenia (р=0,003) as well as nausea and vomiting (р=0,027) after the 1st line of chemotherapy in Group 1. Also a correlation between the presence of sarcopenia (Prado cut-offs) and post-operative mortality was found (р=0,024). Sarcopenic obesity increased the rate of severe complications (p=0,033) as well as mortality (p=0,005) in Group 2.

Conclusion. Cachexia and sarcopenia develop in more than a half of gastric cancer patients before the beginning of the treatment. Those factors increase both the rate of asthenia during chemotherapy and severe complications after surgery.

Introduction. A comparative analysis of the treatment of 98 patients with purulent inflammatory diseases of the hand and insulin-dependent diabetes mellitus in the early postoperative period using traditional methods and special software was carried out. The high efficiency of the software in the selection of surgical access for the early cleansing of an infected wound and shortening the time of hospitalization is shown.

The purpose of the study. To evaluate the clinical effectiveness of using software to select the optimal surgical access in patients with surgical hand infection and type 1 diabetes mellitus.

Materials and methods. A clinical study was conducted based on the treatment of 98 patients with purulent inflammatory diseases of the hand and diabetes mellitus. The study was conducted in the early postoperative period prospectively and retrospectively.

Results. Studies have shown the high efficiency of using special software in the preoperative period in order to select the optimal surgical access and further combat pain syndrome, edema and improve microcirculation and, as a result, create favorable conditions for wound healing and reduce the time of hospitalization.

Conclusion. The use of special software in the preoperative period in patients with surgical infections of the fingers and hand in the presence of type 1 diabetes mellitus allows you to choose the optimal surgical access to further improve lymph outflow and microcirculation, more effectively combat edema, pain syndrome, which are important elements of a favorable course of the wound process.

Introduction. The formation of pathological scar tissue and contractures in patients operated on for phlegmon of the upper limb often leads to a significant decrease in the quality of life, and sometimes a change in work activity. Finding a solution to this problem is urgent. Purpose of work: to improve the quality of surgical treatment of patients with phlegmon of the upper limb by optimizing treatment tactics to prevent pathological formation of scar tissue.

Materials and methods of research. To carry out complex treatment aimed at preventing pathological scar formation in patients with phlegmon of the upper limb (shoulder and forearm), an individual algorithm was developed, depending on the type of acetylation to determine treatment tactics. The study involved 134 patients with deep intermuscular phlegmon of the shoulder and forearm, divided into two groups: the first group included 62 patients, who were treated using known technologies. In group II (72 patients), a developed method for the prevention of hypertrophic scars was used, which significantly improved the results of complex treatment and improved the quality of life.

Conclusion. During the study, it was found that the use of an original method of preventing pathological scar formation in the treatment process is pathogenetically justified. It has proven its effectiveness clinicall, good treatment results were obtained in 94,4 %.

Introduction. Radiation therapy, which has long been a standard element of the neoadjuvant stage of combined treatment of locally advanced rectal cancer, has made significant progress in preventing local recurrence of the disease. The desire to improve the efficiency of local control, as well as to influence the risks of systemic relapse, led to the development of the concept of total neoadjuvant therapy.

Results. The article is a review of modern publications analyzing the results of the use of total neoadjuvant therapy. A number of recent randomized clinical trials have demonstrated the effectiveness of this approach, achieving an improvement in disease-free and overall survival, and a reduction in the incidence of distant metastasis of rectal cancer. At the same time, no negative impact of neoadjuvant chemotherapy on the frequency of radical resection, the quality of total mesorectumectomy, or the structure of postoperative complications was recorded. Similar results were noted in a number of published meta-analyses examining the effectiveness and safety of total neoadjuvant therapy.

Conclusions. The combination of radiation therapy and systemic chemotherapy in the preoperative period offers hope for improving the results of treatment of locally advanced rectal cancer. Indications for total neoadjuvant therapy, the optimal regimen and frequency of chemotherapy cycles currently still need to be clarified.

Ultrasound as well as mammography are the priority modalities in the differentiation of breast diseases in men, as they have an optimal ratio of efficiency to ease of investigation. In contrast to, for example, invasive histological examination, which is highly effective but traumatic. Or computed tomography, which has a high radiation load, because of which it is not possible to carry out studies to fix the dynamics of the disease. At the same time, studies of gynaecomastia show a high prevalence in the population, despite the fact that most men do not pay attention and do not know that they may have this pathology. Although this pathology is a significant risk factor for breast oncology. Therefore, the purpose of this review is to summarise the signs that you may see with these two instrumental examinations. They allow with a high degree of probability to allow you to make a tentative diagnosis. At the same time, often these studies together with physical examination methods are sufficient even for a definitive diagnosis, although the sensitivity and specificity of the methods do not reach 100% of the results. This leads to the fact that ultrasound and mammography can be used as the first line of diagnosis of gynaecomastia.

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