Introduction. The acute form of mesenteric ischemia is still an urgent and important problem of modern surgery, especially its early diagnosis. There is no tendency to decrease mortality rates from this form of the disease. Over the years, it has been 65–95 %. Due to the need to minimize the time of diagnosis of mesenteric ischemia, research is underway aimed at creating and evaluating the effectiveness of new diagnostic markers that could indicate ischemia of the intestinal wall by changing their concentration and make it possible to perform surgical treatment at the earliest possible time. According to the literature, a new clinical and laboratory indicator has similar characteristics – the intestinal form of fatty acid binding protein (Intestinal Fatty Acid Banding Protein, (I-FABP).

The purpose of the study. To evaluate the diagnostic value of the fatty acid binding protein (I-FABP) as the primary marker of ischemic small intestine lesion based on our observations.

Materials and methods. A single-center clinical and laboratory comparative study included 31 patients from 34 to 91 years old who were admitted to the State Medical Institution “State Clinical Hospital named after V.V. Veresaev DZM”, urgently with the clinic of acute mesenteric circulatory disorders in the period 2022-2023.

Results. The maximum concentrations of I-FABP in the blood serum are detected 2–3 days after the onset of the vascular “catastrophe”. In all cases, thrombosis was the cause of ONMpC. Mesenteric arterial thrombosis as the cause of OMI occupied a leading place, accounting for 71 % of cases (n = 22), whereas venous thrombosis was diagnosed in 29 % of patients (n = 9). The value of I-FABP in patients with arterial thrombosis was not much higher than the value of the marker in patients with venous OMI. The average concentration of I-FABP in deceased patients was significantly higher than that in survivors.

Conclusion. Laboratory determination of the intestinal form of fatty acid binding protein in blood serum has every chance of being introduced into the diagnostic algorithm for patients with suspected forms of mesenteric circulatory disorders, which will reduce the diagnostic time, choose the optimal treatment tactics and improve treatment results. 

Introduction. Due to the paucity of scientific studies on alloplasty techniques for postoperative anterior abdominal wall hernias, further research is needed and important.

The purpose of the study. To compare in an acute experiment the biomechanical results of alloplasty with and without mesh implant fixation.

Materials and methods of research. 18 laboratory rats of Standard breed, weighing 400±50 g, were used as biological models in the experiment. In the experimental operating room under general anesthesia in aseptic conditions the animals underwent alloplasty with a mesh implant (Esfil, RF) according to the sublay technology. Two observation groups were formed (9 operated rats in each group) depending on the method of alloplasty. In the 1st group alloplasty with fixation of the implant with through U-shaped sutures was performed. In the 2nd group the implant was not fixed in the retromuscular bed. On the 21st day the material was taken for biomechanical study. The biomechanical properties were assessed by means of a tensile machine «INSTRON-5944».

Results. It was found that the difference in biomechanical indices after modeling prosthetic alloplasty with two different techniques (with and without fixation) was not statistically significant in the area of elastic-plastic deformations.

Conclusion. In the experiment it was proved that the biomechanical strength of separation alloplasty does not depend on the method of fixation of the implant to the abdominal muscles.

Introduction. According to WHO, the number of people with stoma approaches to 100–150 people per 100,000 population. Currently a significant number of patients require reconstructive surgery.

Purpose of the study. To improve the results of reconstructive operations in patients with single-barrel colostomy.

Materials and methods of research. We monitored 96 patients with single-barrel colostomy, age 23–85. Stoma was formed during surgical interventions: after resection of the colon for cancer - in 61 patients (63,5 %), in 29 (30,2 %) – due to complications of diverticular disease of the colon, in 6 (13,5 %) – due to traumatic colon injury. Subsequently, 66 patients within 3 months to 4 years, underwent reconstructive surgery - elimination of the stoma and formation of a colorectal anastomosis. 30 (45 %) were men and 36 (55 %) women.

Treatment results. Postoperative complications detected in 5 (7,5 %) of 66 operated patients. 4 (6 %) cases had suppuration of the postoperative wound. Another 1 (1,5 %) patient was diagnosed with incompetent transversorectal anastomosis causing diffuse purulent peritonitis, resulting in death from progression of abdominal sepsis and multiple organ failure.

Conclusion. For more than 2/3 of patients with a single-barrel colostomy, it is possible to perform a reconstructive operation involving elimination of the stoma within 4–12 months. When performing reconstructive surgery, factors to be considered are metabolic status of the patient, and the condition of the stoma. Prior to surgery, the surgeon must select the type of intestinal anastomosis (mechanical or manual) and the optimal method to form an anastomosis (end to side or end to end), taking into account the anatomical features of the pelvis and preserved rectum.

Introduction. For a long time, progression of the underlying disease was considered the main reason for the development of recurrence (in particular, due to the reasons described above). However, to date, the results of numerous comparative studies demonstrate that in some cases the development of clinical and radiological relapse of the disease is due precisely to non-compliance with the technical aspects of the primary antireflux intervention.

Purpose of the work: to assess the causes of recurrence of hiatal hernia and GERD in a group of patients, to determine the key aspects leading to relapse, and to introduce the term “failed fundoplication.”

Materials and methods. The study evaluated 56 patients who underwent laparoscopic revision fundoplication. In all patients, the following parameters were assessed: absence of isolation of the abdominal part of the esophagus, absence of cruroplasty, absence of an antireflux mechanism (signs of the use of absorbable suture material), compression of the esophagus (by a mesh implant or hyperfunction of the cuff), the presence of an “old” hernial sac (which was not removed in previous operation), lack of fixation of the fundoplication cuff to the esophagus, injury n.vagus, technically incorrectly formed fundoplication cuff.

Results. In all patients, technical errors of the primary intervention were identified which, was a recurrence of GERD and hiatal hernia.

Conclusion. Fulfillment of the proposed technical errors are predictors of programmed recurrence of hiatal hernia and GERD. Intraoperative identification of these errors suggests that the primary antireflux intervention was a “failure.”

Introduction. The aim of this study is to evaluate the effectiveness of laboratory indices of inflammatory response in predicting the development of acute appendicitis in children.

Materials and methods. Data on 300 pediatric patients who underwent appendectomy for acute appendicitis at the surgical department of the State Healthcare Institution "Ulyanovsk Regional Children's Clinical Hospital" in Ulyanovsk were retrospectively analyzed for the period from September 1, 2023, to June 1, 2024.

Results. Upon analyzing the results, it was revealed that phlegmonous appendicitis (145 cases) occurs statistically significantly more often in the age group of 6–12 years (𝑝=0,048). Univariate statistical analysis showed that the statistically significant parameters depending on the type of acute appendicitis are vomiting (𝑝 <0,001) and the time interval from the onset of the disease (appearance of the first symptoms) to the performance of surgical intervention (𝑝<0,001). Univariate statistical analysis of instrumental-laboratory parameters yielded the following statistically significant indicators of acute appendicitis development: Ultrasound signs of inflammation of the vermiform appendix (𝑝<0,001), Garkavi index (𝑝<0,001), LII (Leukocyte intoxication index) (𝑝<0,001), NLI (Neutrophil-lymphocyte index) (𝑝<0,001), and TLI (Thrombocyte-lymphocyte index) (𝑝<0,001).

Conclusion. Among pediatric patients, acute appendicitis most commonly occurs in the age group of 6–12 years and is diagnosed as phlegmonous appendicitis. Significant indicators that allow determining the development of acute appendicitis and the nature of its course include: NLI, TLI, LII, Garkavi index, and the results of ultrasound examination of the vermiform appendix. The comprehensive use of these indicators in the diagnosis of acute appendicitis will allow for the timely diagnosis of the condition.

Introduction. Chronic venous insufficiency is a frequent vascular pathology leading to vascular surgical treatment. One of the important aspects of the treatment of chronic venous insufficiency is surgical correction of perforating refluxe. The work is devoted to the intraoperative study of the structure of the perforant veins of the lower leg using a surgical microscope and the application of the knowledge gained in practice.

Materials and methods of research. Intraoperative study of the structure of perforating veins of the leg using a surgical microscope during surgical interventions in 25 patients. Analysis of the obtained data with the control group, application of acquired knowledge in practice.

Treatment results. As a result of this study, during perforantectomy, only the veins were crossed, preserving the satellite structures. This was considered necessary to prevent disruption of the trophism of paravenous tissues. As a result of this study, during perforantectomy, only the veins were crossed, preserving the satellite structures. This was considered necessary to prevent disruption of the trophism of paravenous tissues.

Conclusion. Improved results of surgical perforantectomy when using isolated intersection of perforating veins with preservation of satellite structures, compared with standard phlebectomy.

Introduction. Endothelial dysfunction is a predictor of the development and progression of atherosclerosis, in particular, obliterating atherosclerosis of the arteries of the lower extremities.

The purpose of the study. To study the relationship between endothelial dysfunction and the state of the microcirculatory bed 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. The content of markers of endothelial dysfunction, endothelium-dependent vasodilation of the brachial artery and microcirculatory bed was assessed in 135 patients 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. The patients were divided into two groups, one group with stage III ischemia, the other with stage IV limb ischemia.

Results and discussion. The results of the study showed that there is a statistically significant increase in the level of markers of endothelial dysfunction, a decrease in endothelium-dependent vasodilation of the brachial artery. Higher values of these parameters were found in patients with stage IV ischemia. In patients with grade III limb ischemia, according to computer capillaroscopy, the number of linear working capillaries was 5,5±2,4 pcs. per 1 mm², and the number of working capillaries by area was 16,7±5,3 pcs. per 1 mm², with grade IV ischemia, the number of linear working capillaries was 3,3±1,3 pcs. per 1 mm², and the number of working capillaries by the area is 5,7± 2,8 pieces per 1 mm².

Conclusion. In case of 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, the phenomenon of endothelial dysfunction and changes in the microcirculatory bed, more pronounced in the IV degree of ischemia, is noted.

Introduction. Patients with thoracic aortic pathology are one of the most difficult categories of patients, however, the informative value of high-sensitive troponin I during reconstruction of thoracic aorta needs to be investigated further.

Aim. To determine the correlation between the high-sensitive troponin I and risk of postoperative complications in patients operated on thoracic aorta.

Methods. A prospective observational single-center study, which included patients operated on the ascending aorta and aortic arch. Blood samples were taken for troponin I before the induction of anesthesia, at the end of the operation and 6 hours after the end.

Results. The study included 112 patients, 58 of them underwent surgery on ascending aorta and 54 on aortic arch. Correlation between growth of highly sensitive troponin I was observed with time of artificial circulation, myocardial ischemia both at the end of the operation (R = 0,4 p<0,001; R = 0,55 p<0,001) and after 6 hours (R = 0,43 p<0,001; R = 0,52 p<0,001). In the postoperative period, the need for inotropic support for ≥ 24 hours was observed in 8 patients in ascending aorta group and 7 patients in aortic arch group. ROC analysis for inotropic support showed cut-off levels for troponin I: at the end of surgery, more than 1,04 ng/ml (sensitivity 75 %, specificity 71,3 %, AUC 0,785), 6 hours after surgery, more than 1,565 ng/ml (sensitivity 81,3 %, specificity 71,6 %, AUC 0,794).

Conclusion. Highly sensitive troponin I is a significant predictor of inotropic support requirement in the postoperative period.

Introduction. Acute limb ischemia in patients with COVID-19 is a serious complication with a high risk of limb loss and mortality. Despite the growing number of studies devoted to this problem, there is no consensus on the optimal revascularization strategy. The purpose of this study was to compare the long-term results of open and endovascular interventions in patients with acute limb ischemia in acute stage of COVID-19.

Methods. Study included 257 patients with acute limb ischemia IIA-IIB class Rutherford, hospitalized in the period from 01.01.2018 to 20.06.2023. The patients were divided into four groups: I (n=50) and II (n=50) – controls without COVID-19; III (n=86) and IV (n=71) – with COVID-19. Open revascularization was performed in groups I and III, and endovascular revascularization with catheter-directed selective thrombolysis was performed in groups II and IV. Patency of the reconstructed arteries was assessed 6–12 months after surgery using ultrasound and CT angiography.

Results. The incidence of late retrombosis was 41,3 % in the open revascularization groups and 33,3 % in the endovascular treatment groups. In patients with COVID-19, after open surgery, recurrence of acute limb ischemia was observed 2 times more often (8,7 % vs. 4,4 %), but the overall frequency of retrombosis was comparable. The development of stage III-IV chronic ischemia (Rutherford) was more typical for patients after open interventions (17,6 % vs. 7,3 %).

Conclusions. Endovascular revascularization with catheter-directed selective thrombolysis for acute ischemia in patients with COVID-19 is associated with a lower incidence of recurrent acute ischemia and the development of chronic arterial insufficiency in the long term compared to open surgery and is the optimal revascularization strategy in this group of patients.

Introduction. Acute peripheral arterial thrombosis, which develops against the background of COVID-19, significantly worsens the prognosis of survival. Open revascularization is the method of choice for acute limb ischemia (ALI), but in conditions of coronavirus infection it is associated with a high risk of retrombosis. The aim of the study was to assess the quality of life of patients who underwent open revascularization for acute acute respiratory tract infection in the acute stage of COVID-19, in comparison with patients without viral infection.

Methods. The study included 136 patients with ALI who underwent open thrombectomy, endarterectomy and artery plasty. The main group (n=86) – patients with COVID-19, the control group (n=50) – without infection. The quality of life was assessed using the SF-36 questionnaire at discharge and after 12 months. The statistical analysis was carried out in the "R" software environment.

Results. In the early postoperative period, the quality of life of patients with COVID-19 was significantly lower on 7 out of 8 SF-36 scales. After a year, the indicators improved, but did not reach the level of the control group on the scales of physical pain, vitality and role functioning. The physical and mental components of health were lower by 13 % (p˂0,02) and 10 % (p˂0,01), respectively.

Conclusions. COVID-19 negatively affects the results of open revascularization in ALI. The quality of life of such patients in the long-term period remains below the average population, which requires consideration during medical examination and rehabilitation.

Introduction. The extent of lymphatic spread of cancer in colon lesions determines the treatment options and prognosis for the patient.

The purpose of the study. To study the pattern of lymph node metastasis in left colon cancer.

Materials and methods. 53 pathomorphological studies of the surgical material after preliminary detailed preparation by the surgeon were analyzed from March 2022 till December 2023.

Treatment results. After segmental colonic resection with D3 lymph node dissection and selective vascular ligation, a median number of 62 (IQR: 38-20) regional lymph nodes were excised. A median of 11 (IQR: 6-2) apical lymph nodes were removed. The median number of metastatic paracolic nodes was 9 lymph nodes (IQR: 4-0). There were 4 metastatic intermediate lymph nodes in median (min-max: 0–8), and 1 metastatic lymph node in the apical group. The metastatic spread in apical lymph nodes occurred in 3 of 53 patients (5,7 %,). Apical lymph node metastasis occurred only in sigmoid colon cancer in 7,1 % of cases.

Conclusion. Metastatic apical lymph node spread is found in sigmoid colon cancer. Complete lymph node dissection with tumor-specific mesocolic excision allows to perform more accurate staging and radical surgery in patients with left colon cancer.

Introduction. In order to prevent severe digestive disorders after gastrectomy, more than 70 options for restoring the digestive tract have been proposed, but there is no single method of choice, as there are no studies proving the advantage of one or another method of reconstruction.

Aim: To study the digestive function in patients after gastrectomy with jejuna gastroplasty (JGP), by comparative analysis with a standard Roux-en-Y.

Materials and methods of research. A comprehensive examination of 64 patients who underwent gastrectomy at the Vishnevsky National Medical Research Center of Surgery was conducted at the Federal Research Centre of Nutrition and Biotechnology. Depending on the variant of reconstruction of the digestive tract, patients are divided into 2 groups: JGP (main) – 41 (64,1%) patients, and the Roux-en-Y (control) – 23 (35,9 %).

Results. When examining complaints, it was revealed that patients in the JGP group have a lower degree of abdominal pain, bloating, nausea, bitterness and dry mouth. Impaired absorption of fatty acids (p=0,04) and the soaps formed from them (p= 0,01) are more common in the control group. Quality of life indicators are higher in the JGP group: physical health (55,5±23,9 vs. 46,4±17,7; p=0,03), mental health (59,3±23,2 vs. 52,4±15,6, ns), integral quality of life (58,1±24,3 vs. 49,2±17,0; p=0,008)

Conclusion. Preliminary results of the study of the nutritional status of patients after gastrectomy with JGP indicate a more active intestinal absorption, a lower severity of dyspeptic disorders and better quality of life than in patients with Roux-en-Y.

Introduction. At the same time as the methods of surgical removal of the breast developed, the methods of its restoration were improved. It should be borne in mind that the purpose of breast reconstruction is to recreate a natural, plastic shape and maximum symmetry, therefore, the surgical procedure is selected individually, taking into account the patient's anamnesis and anatomical features.

Materials and methods of research. The tasks described above allow us to solve various variants of autologous reconstruction, one of which is the thoracodorsal flap (TDL flap) – a skin-muscle flap based on the widest back muscle. The article presents a clinical case and describes in detail the course of surgery with all the modifications used.

The results of the treatment. This flap can be used both after mastectomy and in the process of performing organ-preserving surgical treatment in order to replenish the removed area of the breast. The TDL flap is used more for aesthetic reasons than for medical reasons. In its application, it is universal. It is most often used for small and medium-sized mammary glands, but a thoracodorsal flap in combination with an implant is also possible to achieve a larger volume of the reconstructed breast.

Conclusion. The versatility and a number of advantages of using a TDL flap allow us to highly evaluate the importance of this technique in reconstructive surgery and continue to hone our skills, modifying the classical technique of performing taking into account the anatomical characteristics of each patient.

Introduction. Currently, surgical treatment is the main type of therapy for malignant lung neoplasms. This pathology is most commonly found in elderly patients with significant comorbid conditions. These conditions create a risk of cardiovascular complications after surgery, which worsens the postoperative period.

Materials and methods. The article presents an analysis of postoperative indicators in patients from the high-risk group for cardiovascular complications after undergoing lobectomy for malignant lung neoplasms. The subjects were divided into two groups: patients who underwent multimodal prehabilitation (n=39) and the control group (n=36). Before randomization, an assessment of external respiratory function, left ventricular ejection fraction, mean pulmonary artery pressure, and functional test results was performed. The risk assessment for developing cardiovascular complications was conducted according to the proposed risk model.

Results. An analysis of postoperative complications (Grade II–Grade V) showed a lower number of complications in the group of patients who underwent prehabilitation (p=0,020). The frequency of cardiovascular complications in the prehabilitation group was significantly lower than in the control group (p=0,040). The length of hospitalization differed significantly depending on the presence of prehabilitation: in the control group, it was 12,08±2,26 days, while in the prehabilitation group it was 11,05±1,81 days (p=0,031).

Conclusions. The use of a prehabilitation program in high-risk patients may help reduce the risk of developing cardiac complications after surgical treatment of lung cancer.

Introduction. Treatment of extensive wounds as a consequence of necrotizing soft tissue infections is an important problem due to the increasing incidence of this pathology, frequent damage to the working population, the high probability of disability, and the difficulties of reconstruction in conditions of shortage of plastic material.

Objectives. We aimed to asess the effectiveness of using a system for treating wounds using the local negative pressure (LNP) method in patients with necrotizing fasciitis, myositis of the extremities and/or trunk.

Materials and methods. We summarized the results of treatment with the LNP method in 24 patients with necrotizing infections of the soft tissues of the extremities and/or trunk. The treatment regimen included LNP dressing; secondary surgical treatment (SST) of wounds was accompanied by a change in system components. The end point was closure of large wound defects.

Results and discussion. The average number of SSTs after performing primary debridement was 5,86. The average number of changing of the LNP system’s components is 3,7. 7 out of 24 patients reached the final stage, that means the application of secondary sutures or autodermoplasty. The remaining patients were discharged for outpatient treatment with small granulating defects (total wound area less than 1 % of body area). Amputations were avoided in the entire series of cases. The average length of hospitalization was 24,95 days (median – 22, mode –21).

Conclusion. The use of the LNP method in the treatment of patients with necrotizing soft tissue infections let us speed up wound cleansing and make plastic earlier. In the future, upon receipt of confirmation on a statistically significant sample, it is possible to propose the LNP method as a method of choice in the treatment of such patients.

Introduction. Providing highly qualified medical care to patients with combat cardiovascular trauma, which differs significantly from somatic pathology of the circulatory system, required, in modern conditions, a revision of established routine practice, a significantly broader knowledge and experience of specialists.

Purpose of the study. Analysis of current trends in the development of cardiovascular surgery associated with combat trauma.

Materials and methods. A number of features of combat trauma related to cardiovascular surgery and non-standard solutions in specific clinical situations are considered.

Results. The use of the full arsenal of modern methods of diagnosis and treatment of patients with combat trauma and diseases of the cardiovascular system, with high detail, optimization of surgical procedures and minimization of surgical trauma, allowed us to achieve satisfactory clinical results and shorten the rehabilitation period.

Conclusion. Based on the results of our study, we can draw conclusions about the increased contribution of the use of modern technologies in the treatment of patients with wounds and injuries of the cardiovascular system, which simplify and optimize the surgical procedure, and thereby improve the prognosis of long-term survival and the quality of life of victims.

Introduction. Unfortunately, at present there are still quite a large number of local military conflicts in which not only servicemen but also civilians are injured.

Purpose of the study. To study the main anatomical injuries in gunshot wounds of the uterus and their influence on the choice of surgical treatment.

Materials and methods of research. We analyzed the results of treatment of 86 female patients who received gunshot wounds in the pelvic region from the civilian population in the local armed conflict with uterine injury. The average age was 36±5 years. Taking into account the time of delivery, all the wounded were divided into 2 subgroups: the 1st group included 45 (52.3%) women whose delivery time to the medical institution did not exceed 1.5 h; the 2nd group included 41 (47.7%) women whose delivery time exceeded the specified time limits.

Results. The study shows that multiple wounds predominated in both groups. In those cases where the uterine wound was superficial, the wound was not the source of peritonitis.

Conclusion. It has been confirmed that in cases where the uterine wound is superficial, the wound is not a source of peritonitis and organ-preserving operations should be preferred. But, in those cases when the number of wounds exceeds three, regardless of the penetrating or non-penetrating nature of the wound, preference should be given to uterine extirpation, as suturing in such cases is accompanied by deformation of the uterus with subsequent impairment of childbearing function.

Introduction. Aesthetic surgery is becoming more and more in demand every year. The main area of the face requiring correction is the periorbital area. Blepharoplasty is used for surgical correction of age-related changes in this area. Among the methods of surgical rejuvenation of the lower eyelid, most plastic surgeons prefer lower blepharoplasty with fat transposition.

The aim of the study was to evaluate the cosmetic effect and the frequency of complications during lower blepharoplasty with transposition of fat compartments of the lower eyelid.

Materials and methods. The study included 68 patients who underwent lower percutaneous blepharoplasty with transposition of fat lumps of the lower eyelid in 2022–23. All the patients were female. The age ranged from 35 to 57 years old. The reason for contacting a plastic surgeon in all patients were complaints about the presence of a fatty hernia in the lower eyelid area, the so-called "bags under the eyes".

Results and discussion. On the 7th day after the operation, the majority (95.6%) of patients noted full satisfaction with the cosmetic result. Upon examination a month later, 98,5 % of patients noted complete satisfaction with the cosmetic effect of the operation.

Conclusions. The cosmetic effect of lower blepharoplasty with transposition of fat compartments of the lower eyelid was evaluated. Most of the patients noted a positive result of the surgical intervention. Lower blepharoplasty with transposition of fat compartments can be recommended as the surgery of choice to eliminate fatty hernias of the lower eyelid.

Introduction. Human echinococcosis is a serious parasitic disease that requires surgical treatment and is characterized by a high rate of complications and recurrences. According to published data, the global incidence of this disease is more than one million cases per year and continues to increase steadily.

The main part. The article discusses the main diagnostic methods and modern achievements in the immunological verification of the diagnosis. It also discusses the problems related to the lack of standardized approaches to choosing a treatment method for different localizations and multiple and combined lesions. The article analyzes different treatment options for echinococcosis, examines the statistics of the results, and draws conclusions about the advantages and disadvantages of active surgical treatment compared to other methods. It describes modern minimally invasive techniques and the importance of using chemotherapy with antiparasitic drugs, emphasizing the need to combine them. Special attention is paid to the most common location of echinococcal cysts – in the lungs, where the expediency of organ-sparing operations is highlighted.

Conclusion. Despite the successes achieved in the fight against human echinococcosis, there are still some issues that have not been fully addressed. The addressing of these issues could lead to better treatment outcomes for this disease.

Introduction. Surgical patients account for almost a third of all cases of sepsis, its treatment means higher costs, longer duration, risk of complications. Biomarkers in case of early diagnosis and can also play a crucial role in assessing the effectiveness of treatment.

The purpose of the study. To study the features of sepsis diagnostics using biomarkers and their effectiveness in surgical practice.

Materials and methods of research. Data were reviewed in PubMed, CochraneLibrary, ScienceDirect, eLIBRARY. The following criteria were applied to exclude the analyzed materials: description of individual clinical cases; books and documents; comparison of treatment results. 116 sources were initially identified and 51 sources were included in the analysis.

Results. Today there are several groups of biomarkers used in this pathology. Consistently elevated CRP and PCT levels correlate with septic complications. But for a reliable interpretation of the results, they should be determined over time. In the group of proinflammatory cytokines, IL-6 is the most commonly used but it is not reliable enough as a criterion and is used to a limited extent in clinical practice. Presepsin is best suited for early diagnosis but its use is limited by high cost of tests and lack of a clearly defined threshold.

Conclusion. Biomarkers are widely used in the early diagnosis of sepsis, predicting the outcome and as an additional criterion for choosing rational antibiotic therapy. However, so far the "ideal" biomarker of sepsis has not been determined, an assessment of their use and the possibility of their combined use are required.

Introduction. Mediastinitis is an aseptic or microbial inflammatory process in the mediastinal tissue, which can occur acutely or chronically. Descending mediastinitis is an inflammation of the mediastinal tissue with the primary focus of infection in the head and neck area, which, going down through the fascial spaces, spreads to the structures of the mediastinum.

Purpose of the study. Review of the evidence base for the diagnosis and treatment of descending mediastinitis.

Materials and methods of research. A literature search of primary scientific studies on descending mediastinitis was conducted in Russian, English and German in the electronic libraries eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the biomedical database PubMed.

Results and discussion. There are three main fascial routes through which infection from the oral cavity or neck region can reach the mediastinum: pretracheal, lateropharyngeal and retropharyngeal. About 70% of cases are the retropharyngeal route. Mortality with descending mediastinitis reaches 40%. Based on computed tomography data, focal (type I) and diffuse (type II) descending mediastinitis are distinguished. The clinical manifestations of the disease are nonspecific and are similar to other systemic infections and septic conditions. The main treatment consists of antibiotic therapy and surgical debridement of the source of infection. The choice of surgical approach depends on the type of descending mediastinitis and the experience of the surgeon. There is still controversy regarding surgical treatment methods and the duration of antibiotic therapy.

Conclusion. Because descending mediastinitis is a potentially life-threatening condition, it should always be considered an emergency.

Groin hernias are common in the human population: they occur in 27–43 % of men and 3–6 % of women. They account for 80 % of all abdominal hernias. Hernioplasty is one of the most commonly performed surgical interventions. Currently, non-tension hernioplasty is actively used. The Lichtenstein method of inguinal hernia repair and laparoscopy are the most common techniques worldwide.

The results of the review show that different techniques of open and laparoscopic procedures with mesh hernioplasty have no significant effect on male infertility. However, prosthetic mesh hernioplasty may lead to adverse events such as ejaculatory duct obstruction, obstructive azoospermia, oligospermia, and the development of infertility in the male population due to fibrosis resulting from postoperative bleeding, adhesions, and postoperative exercise friction. Additional factors that may affect infertility may include patient age, employment status, psychological factors, and environment.

Overall, it can be noted that the main attention should be focused on the standardization of surgical procedures and methods of prevention of intra- and postoperative complications in order to avoid or reduce their pathological impact on the reproductive health and quality of life of the patient.

Introduction. At the present stage, the problem of providing specialized emergency surgical care to patients of older age groups is one of the urgent clinical tasks.

Results. The review analyzes from various positions a wide variety of factors of negative prognosis in acute appendicitis (AA) in an elderly cohort of patients. Epidemiological patterns of AA prevalence in elderly and senile individuals differ significantly from those in the younger population. Even without taking into account the undeniable factor of multimorbidity, older patients are characterized by later hospitalization, a wide variety of alternative urgent diagnoses, a higher frequency of AA complications and its treatment and, as a natural result, higher hospital mortality than among younger patients. Among the reasons for such patterns are: a wide incidence of atypical course of appendicitis, worse overall accuracy of modern clinical and laboratory diagnostic methods and a longer duration of preoperative diagnosis. In the global and Russian national paradigm of AA treatment, there is a key contradiction in the attitude towards non-surgical treatment of AA, and in its most acute form it is manifested in the example of elderly patients, for whom the frequency of appendectomy in Western countries is lower than for younger patients.

Conclusions. Diagnosis and treatment of AA in older people is a much more complex and technologically advanced process than in younger patients, which necessitates the need for surgeons to focus increased attention on this contingent of patients.