Introduction. Severe digestive disorders after primary gastric surgery in 25 % of patients lead to permanent disability and 100 % require medical rehabilitation. Progressive forms of postgastrectomy syndromes (PS) are an indication for reconstructive intervention.

Aim. To improve the functional results of repeated gastric surgeries by using the jejunogastroplasty.

Materials and methods of research. In the period from 2012–23, 56 repeated operations on the stomach using a jejunogasroplasty were performed at the department of A.V. Vishnevsky National Research Scientific Surgical Center (NRSSC). These patients had previously undergone resection and gastric drainage operations. Indications for the next intervention in 45 (80,4 %) patients were PS, and in 11 (19,6 %) – gastric stump cancer and recurrence of gastric cancer (GС).

Results. In the postoperative period, surgical complications developed in 4 (7,1 %) patients. The hospital mortality rate was 1.8%. In the long-term period, a decrease in the frequency and severity of the disease was revealed, as well as improvements in the quality of life (QOL) of patients.

Conclusion. Reconstructive operations with plastic replacement of the whole stomach or part of it with a segment of the jejunum and inclusion in the passage of the duodenum, most of all correspond to normal physiology, creating conditions for the portioned intake of food into the small intestine, and bringing the activity of the digestive system closer to normal.

Introduction. Minimally invasive endoscopic treatment methods aimed at the destruction of heterotopic gastric mucosa in the cervical esophagus and relief of clinical symptoms are of priority importance.

The purpose of the study. To study the effectiveness, compare the standard and modified radiofrequency ablation (RFA) protocol in symptomatic patients with heterotopic gastric mucosa in the cervical esophagus.

Materials and methods of research. The results of endoscopic RFA were studied in 14 patients: 7 patients underwent RFA according to the protocol for the treatment of Barrett's esophagus, the rest of the patients – modified protocol of RFA.

Treatment results. Eradication of heterotopic gastric mucosa in the cervical esophagus was achieved in 100 % of patients. The use of modified protocol of triple RFA exposure allowed to reduce the number of sessions required for eradication of gastric heterotopia in the cervical esophagus – 2.0 (2.0; 2.0) versus 1.0 (1.0; 1.5), p=0.035. Decreasing in the total score of RSI scale was revealed comparing the severity of laryngopharyngeal symptoms after RFA eradication of heterotopia after 8 months – 3.0 (1.75; 5.0) compared to the total score of RSI scale after conservative therapy – 16.5 (13.75; 22.5), p=0.001.

Conclusion. Endoscopic RFA in patients with heterotopic gastric mucosa in the cervical esophagus demonstrate efficacy and safety.

Introduction. A comprehensive assessment of the nature of the course and severity of acute pancreatitis, based on substantiated prognostic factors, is the most important task of modern clinical medicine.

Objective of the study. To assess the prognostic significance of clinical and biochemical parameters in different forms of acute pancreatitis.

Materials and methods of the study. The study involved 120 patients with acute pancreatitis of varying severity. The average age of the patients was 48±14 years. The following methods were used: collection of anamnesis, clinical, laboratory, instrumental methods.

Treatment results. Mild acute pancreatitis is characterized by the following biochemical features: leukocyte intoxication index (LII) within 6.28±4.5, moderate increase in amylase activity (679.5±67.5 U/l), transaminase levels (AST 126±14.5 U/l, ALT 123±16.1 U/l), C-reactive protein concentration (34.9±6.2 mg/l) and fibrinogen (367±99.8 mg/l). A relatively low diastase level is noted (1531±157 U/l). With a moderate course of the disease, more pronounced deviations in a number of indicators are observed. Severe acute pancreatitis is characterized by the most severe changes in biochemical indicators. A decrease in the concentration of hemoglobin (125±21 g/l) and platelets (205±112×10^9/l) is revealed, which may indicate more pronounced disorders of the hemostasis system.

Conclusion. A comprehensive assessment of laboratory parameters allows stratifying patients by the risk of developing complicated acute pancreatitis with subsequent optimization of treatment tactics.

Introduction. Treatment of patients with postoperative ventral hernias is an urgent problem in general surgical practice. According to clinical recommendations, there is no single “gold standard” for the treatment of patients with midline incisional ventral hernias.

Purpose of the study. To compare the results of treatment of patients with midline incisional ventral hernias using IPOM plus and eTEP RS.

Materials and methods of the Study. A prospective randomized controlled trial (RCT) was initiated on the basis of N.I. Pirogov State Clinical Hospital No.1. Inclusion criteria: patients of both sexes from 18 years old, presence of midline postoperative hernia, width of hernia defect from 2 to 6 cm inclusive, ASA I-II. The study was performed according to the protocol published on ClinicalTrials.gov after obtaining approval from the hospital ethical committee. The study protocol initially outlined an interim analysis of outcomes after achieving greater than 50 % patient enrollment.

Treatment outcomes. Between February 2023 and April 2024, 45 patients were enrolled in the study: eTEP RS (n=23), IPOM plus (n=22). Pain syndrome at 6 h, 24 h, at discharge and at 7 days was significantly less severe in the eTEP RS group compared to the IPOM plus group (p= 0,0001; p= 0,003; p=˂0,0001, p= 0,0003). Chronic pain syndrome was more frequent in the IPOM plus group n=6 (28,6 %), versus 3 (12,5 %) in the eTEP RS group. Wound complications were more prevalent in the IPOM plus group (7 (31,8 %), p= 0,03), due to the number of seromas.

Conclusion. The interim results show a lower incidence of pain in the postoperative period and a lower incidence of chronic pain syndrome with the eTEP-RS technique.

Introduction. The article presents an analysis of bacteriological studies of bile and abdominal effusion in 32 patients with acute biliary pancreatitis in the early postoperative period. Acute biliary pancreatitis accounts for up to 60 % of all cases of acute inflammation of the pancreas. Infection with destructive forms reaches 70 %, significantly increasing mortality. The current strategy of antibacterial therapy requires bacteriological confirmation of contamination.

The purpose of the study. To study the risk of bacterial contamination of bile and abdominal effusion in acute biliary pancreatitis in the early postoperative period.

Materials and methods. Bile and effusion samples were examined in 32 patients after laparoscopic cholecystectomy with drainage. Bacteriological studies were performed according to standard methods with an assessment of qualitative and quantitative indicators. Sampling was carried out on the first day after the operation and 3 days later.

Results. The risk of bile contamination and effusion was high (43,75±8,77 % and 37,50±8,56 %, respectively). By the third day, there was a decrease in the risk of contamination to 28,13±7,95 % and 25,00±7,65 %. In patients with severe disease, a significantly high level of contamination of both media was maintained. The predominant pathogen was Escherichia coli, mainly in monoculture. The level of bacterial.

Conclusion. The most common pathogen is Escherichia coli. The lowest level of antibiotic resistance was noted to fourth-generation cephalosporins, carbapenems, vancomycin.

The continuing high postoperative mortality rate in advanced peritonitis complicated of sepsis and septic shock indicate not only the complexity of the problem, the difficulty of its radical solution for many decades, despite modern achievements in intensive care and surgery, but also the need for further search for various methods and strategic approaches in the treatment of this category of patients. To date, there are still no clear criteria for the use of one or another surgical strategy for the treatment of peritonitis. Many prognostic scores are mainly aimed to assess the risk of mortality and are characterized by complex calculations with the determination of a large number of parameters.

Introduction. Assessing the severity of peritonitis is a difficult task that carries a certain layer of subjectivity, multiplied by the experience of the surgeon and the severity of the patient's condition with peritonitis. The score for peritonitis helps the surgeon in deciding on the choice of treatment strategy for a patient with peritonitis.

The purpose of the study. An attempt to create a new stratification scale for patients with advanced peritonitis to select the type of access and subsequent patient management strategy.

Materials and methods of research. A retrospective analysis of 634 patients with advanced peritonitis for the period 2011–2019.

The results of the treatment. The Generalized Peritonitis Strategy Score for advanced peritonitis has been developed.

Conclusion. The Generalized Peritonitis Strategy Score for advanced peritonitis demonstrates the potential in predicting not only the level of postoperative mortality, but also the choice of surgical intervention access and subsequent surgical management strategy for patients with advanced peritonitis.

Introduction. Severe acute pancreatitis is a particularly dangerous form of acute pancreatitis, which is highly likely to turn into pancreatic necrosis, which requires early diagnosis of this condition with the immediate use of all necessary medical and surgical measures.

The aim of the work is to correlate the data of atomic force microscopy of the erythrocyte membrane and the severity of acute pancreatitis to predict and early detect the severity of the course.

Materials and methods. 2 groups of patients with acute pancreatitis with a disease duration of three days from the onset of the disease to the moment of hospitalization were identified. As part of the ongoing study, the condition of peripheral blood erythrocytes of patients was assessed and compared with erythrocytes of healthy people by atomic electron microscopy. The evaluation of the obtained data was carried out by statistical processing.

Results. The surface membrane of erythrocytes was scanned using atomic force microscopy. When receiving images, it was revealed that, unlike the erythrocytes of healthy people, erosions are noted on the erythrocyte membrane in severe pancreatitis. With lightning-fast pancreatitis, the number of erosions increases significantly, the area and depth also becomes larger.

Conclusion. The introduction of atomic force microscopy of peripheral blood erythrocytes into clinical practice can provide significant assistance in the differential diagnosis of severe and lightning-fast acute pancreatitis. Timely and correct determination of the severity of acute pancreatitis will allow to change the tactics of treatment of patients and improve both immediate and long-term results.

Introduction. Thoracoabdominal aortic (TAA) replacement is a complex surgical procedure that requires reconstruction and reimplantation of the renovisceral branches (RVB). The choice of the optimal method for RVB reimplantation plays an important role in achieving long-term success of the operation.

Objective. To analyze and evaluate preoperative parameters of CTA aortography and anatomical and morphological characteristics of RVB and determine their influence on the choice of RVB reimplantation technique during TAA reconstruction.

Materials and methods. At the B.V. Petrovsky Russian Scientific Center of Surgery, a retrospective analysis of data from 120 patients was carried out as part of the study from 01.2018 to 09.2023, who underwent TAA prosthetics with implantation of all RVB. Preoperative data and parameters of the aorta and RVB according to MSCT aortography were evaluated. Patients were divided into three groups; group I — «Crawford» (n=43, 35,8 %), gr. II — «Coselli» (n=32, 26,7 %), III gr. — «buttons» (n=45, 37,5 %).

Results. 1) «Crawford» should be chosen in elderly patients with close location of the RVB ostia in relation to each other, in the absence of connective tissue disease (CTD) and degenerative lesions of the RVB. 2) «Coselli» is appropriate for patients with a large diameter of the aneurysm at the level of the RVB (p<0,001). The technique has an advantage in patients with "shaggy aorta" and morphologically altered RVB (stenosis, occlusion, dissection) – p=0,001 and p<0,050, respectively. 3) The «button» method is advisable to use with a remote reno-visceral location (p=0,001), in patients with CTD (p=0,012) and with variant RVB anatomy (p<0,050).

Conclusion. Preoperative planning based on anthropometric data and MSCT allows developing a strategy for RVB reimplantation, taking into account aortic pathology and minimizing the risk of complications.

Introduction. Acute limb ischemia is an urgent condition in which immediate revascularization is necessary. The risk of complications depends on the age of the patient, the cause of arterial thrombosis of the limb, and the presence of concomitant pathology: Coronary heart disease, CKD, respiratory failure, diabetes mellitus, urgency and duration of surgical treatment.

The aim of the study was to assess the impact of the presented risk factors on the results of endovascular revascularization in acute thrombosis in patients in the acute stage of COVID-19.

Materials and methods. The results of open surgical treatment of Rutherford class II acute limb ischemia in patients with acute stage COVID-19 (71 patients, group I) and 50 patients without COVID-19 (group II) were analyzed. The groups are comparable in demographic and clinical characteristics.

Results. Hospital mortality was 36,6 % in group I and 10 % in group II. The majority of deaths in group I were due to early retrombosis. Risk factors — coronary heart disease, CKD, diabetes and the emergency nature of surgery had a greater negative impact in group I against the background of coronavirus infection.

Conclusion. In patients in the acute stage of COVID-19, endovascular revascularization is associated with a high risk of complications and mortality in the early postoperative period compared with operated patients without coronavirus infection. The influence of all identified risk factors increases against the background of COVID-19, a statistically significant increase in the odds ratio of postoperative complications was revealed for such perioperative risk factors as coronary heart disease, respiratory failure, diabetes mellitus and chronic kidney disease, among the intraoperative factors, the emergency nature of the operation and the duration of surgery are significant.

Introduction. Endovascular revascularization in combination with catheter-controlled selective thrombolysis is the method of choice for the treatment of acute limb ischemia.

The aim of this study was to compare the long-term results of endovascular interventions with the use of selective catheter-controlled thrombolysis in patients with acute stage of new coronavirus infection COVID-19 and without it.

Materials and methods. The study included 121 patients with OIC who underwent endovascular revascularization with selective catheter-guided thrombolysis tissue plasminogen activator alteplase. The study group (n=71) consisted of patients operated on in the acute stage of the new coronavirus infection COVID-19, the control group (n=50) — without infection. Patency of the reconstructed arteries was assessed 6 and 12 months after surgery using ultrasound and CT angiography.

Results. Patency analysis of reconstructed arterial segments showed higher rates in the COVID-19 group both 6 months later (80,0 % vs. 73,7 %, p≤0,598) and 12 months after the intervention (70,6 % vs. 63,8 %, p≤0,621). Although the differences did not reach statistical significance, there was a tendency for better results in the COVID-19 group. The incidence of late retrombosis was 32,8 % in the general endovascular treatment group, while the distribution between the groups was as follows: 10 patients in the COVID-19 group and 13 patients in the control group (p≤0,156).

Conclusion. The present study demonstrates a comparable frequency of adverse outcomes of endovascular interventions in DEC in the long-term period in both patients with and without COVID-19 infection. At the same time, the frequency of late retrombosis and recurrence of DEC in patients of the control group was slightly higher (13,9 % vs. 5,8 %), and the prognosis of recurrence of DEC in the control group was worse.

Aim. To evaluate whether blood preservation and a perioperative clinical pathway might reduce the rate of complications after multivisceral pelvic resections in patients with advanced ovarian cancer.

Materials and methods: From 2018 to 2024 we performed 50 multivisceral pelvic resections in patients with advanced ovarian cancer. Age was 57,4±12,9 years, BMI – 27,9±6,4 kg/m2 . We previously developed and implemented a standardized protocol for blood preservation and perioperative management of patients in order to reduce the number of complications after multivisceral pelvic resections. The protocol included meticulous tissue preparation under magnification and en bloc visceral resections instead of gut wall “shaving” apart of anaesthesiological components. The severity of complications was assessed according to Dindo-Clavien classification.

Results: Duration of operations was 305±99 min, blood loss constituted 242±221 ml, postoperative mortality – 0. Grade II–IVa complications developed in 42 % of cases, surgical site infection – 20 %. Median hospital stay after surgery was 10,5±9,4 days. The only factor that had a significant impact on the incidence of severe complications was the complexity of the operation according to Aletti (odds ratio 7,364, 95 % CI: 1,671 – 32,440, p = 0,007). The volume of intraoperative blood loss ≥ 250 ml remained the only predictor of infectious complications in multivariate analysis.

Conclusion. The use of a standardized perioperative clinical pathway in patients with advanced ovarian cancer allowed us to achieve an acceptable rate of severe postoperative complications after extensive pelvic resections.

Introduction. Colorectal cancer (CRC) is one of the most common malignancies in the world.

The purpose of the study. To evaluate the short-term results of laparoscopic operations with extraction of the surgical preparation through natural openings (NOSES) and mini-laparotomy (CL) in the surgical treatment of colorectal cancer.

Materials and methods of research. A prospective analysis was carried out in the Department of Faculty Surgery № 2 of Sechenov University. Preoperative and postoperative clinical variables of both patient groups were recorded and compared.

Treatment results. The study presents data on 50 patients with verified malignancies in the colon and rectum who underwent laparoscopic surgery with mini-laparotomy or through natural orifices. Fewer patients in the NOSES group received neoadjuvant chemotherapy vs CL group (4 % vs 40 %, p=0,002), the operative time in the NOSES group was shorter vs CL group (254.60±54.39 min vs 304,76±105,39, p=0,040), intraoperative bleeding was less in the NOSES group vs CL group (61,60±40,49 ml vs 132,00±149,92 ml, p=0,028). After surgery, patients in the NOSES group had faster gastrointestinal recovery (1,56±1,19 days vs. 2,68±1,75 days, p=0,011), earlier first postoperative bowel movement (2,16±1,31 days vs. 3,08±1,80 days, p=0,044), and shorter hospital stay (6,04±1,97 days vs. 7,24±1,67 days, p=0,024), lower pain indices on the first, third and fifth postoperative days (2,92±2,08 vs. 4,08±1,73, p=0,037), (2,56±1,66 vs. 3,84±1,68, p=0,009), (1,84±1,84 vs. 3,80±1,71, p<0,001).

Conclusion. This study provides insight into the efficacy and safety of NOSES compared to conventional laparoscopic interventions with mini-laparotomy. The results suggest a potential advantage of this technique, but requires further analysis for a comprehensive evaluation.

Introduction. Primary retroperitoneal and transabdominal approaches are recently described for D3 lymph node dissection for left colon cancer. Both approaches can be technically managed using a system of surgical planes and anatomical landmarks.

Materials and Methods. The study included 28 patients who underwent minimally invasive surgery for adenocarcinoma of the left colon using navigation within virtual surgical planes. Patients were managed by age, sex, body mass index (BMI), ASA, and level of inferior mesenteric artery ligation. As a result, 14 pairs of patients were compared regarding the short-term results of surgery using conventional transabdominal and primary retroperitoneal approaches.

Results. The length of surgery (250 min vs. 305 min, p=0.277), blood loss, harvested apical (3 vs. 2 lymph nodes, p=0.376) lymph nodes were comparable. Time to first flatus (1,5 day vs. 1 day, p=0.874) and first defecation (3,5 days vs. 3 days, p=0.804), hospital stay (8,5 days vs. 8 days, p=0.874), and incidence of postoperative complications (p=0.308) were not different.

Conclusion. Primary retroperitoneal approach can be used as an alternative to transabdominal access in left colorectal cancer surgery. Comparable short-term results of surgical treatment with both approaches may be reached with the use of navigation within surgical planes and anatomical landmarks.

Introduction. For over 12 years, we have been using combined methods of surgical treatment of hemorrhoids based on laser exposure. In 2017, we proposed a method of laser destruction of hemorrhoids in combination with Doppler uncontrolled dearterialization, mucopexy and excision of the external component. Positive treatment results were obtained during the observation period of patients up to 12 months. In this work, we analyzed the results of observation of a group of patients 5 years after surgical treatment.

Purpose of the study. To evaluate the long-term results of a combined method of surgical treatment of hemorrhoids using the method of submucosal laser destruction in combination with Doppler uncontrolled dearterialization, mucopexy and electroexcision of the external component according to indications.

Materials and methods. The study included 188 patients with hemorrhoids of stages 2, 3 and 4. All patients underwent submucous laser destruction of internal hemorrhoids with Doppler uncontrolled dearterialization, supplemented by mucopexy and electroexcision of the external hemorrhoidal component, if indicated, 5–7 years ago. 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 and a power of 10 W was used.

Results. The combined technique provides long-term guarantees against the occurrence of the main symptoms of hemorrhoidal disease – bleeding, the presence of hemorrhoids. It allows eliminating the risk of major postoperative complications – stricture, anal insufficiency, suppuration.

Conclusion. The technique, regardless of the stage and complexity of the disease, helps prevent the development of relapses and postoperative complications.

Introduction. The high frequency of amputations at the level of the shin and hip in patients with purulent-necrotic complications of diabetic foot syndrome is an urgent medical and social problem.

The purpose of the study. To evaluate the effectiveness of the method of direct antegrade endolymphatic ozone therapy in the complex treatment of patients with purulent necrotic lesions in the neuroischemic form of diabetic foot syndrome.

Materials and methods of research. 107 patients with the neuroischemic form of diabetic foot syndrome were treated. Balloon angioplasty of the arteries of the affected lower limb was performed in block I, and endovascular correction of blood flow was not performed in block II patients. In each block of studies, the main group was identified, in which the method of direct antegrade endolymphatic ozone therapy was used, and the control group, where the developed method was not used.

Treatment results. The patients of the main groups showed positive dynamics: in the I block, more than 80 % of patients noted the absence of pain or mild pain; in the II block – 65,2 %. In the main group of block I, compared with the control group, an increase in the duration of treatment was noted by 5,4 %, but the severity of operations was statistically less, 1,08 versus 1,39. Also, in the main groups, there was a decrease in the level of peripheral blood leukocytes and the degree of bacterial contamination of the wound.

Conclusion. Direct endolymphatic application of ozonated solution allows to accelerate the relief of purulent-necrotic processes in patients with chronic lower limb ischemia with diabetic foot syndrome by stimulating the body's own enzyme systems, antihypoxic, antibacterial and detoxifying properties of ozone, reduces the number of high amputations.

Introduction. Secondary hyperparathyroidism is one of the most frequent complications of chronic kidney disease. In the treatment of patients with severe hyperparathyroidism there is no consensus in the choice of surgical tactics.

Aim of the study. To evaluate the effectiveness and safety of surgical treatment of patients with secondary hyperparathyroidism using traditional methods of surgery.

Materials and methods. The data of medical records of 85 patients with secondary hyperparathyroidism and chronic kidney disease were subjected to retrospective analysis of treatment results. Of them, subtotal parathyroidectomy was performed in 58 cases, in 27 cases – total parathyroidectomy with autotransplantation of perithyroid glands into forearm muscles. A comparative evaluation of postoperative complications, changes in parathormone level, incidence of persistence and recurrence of the disease depending on the type of intervention was performed.

Results. In 36,2 % of observations after subtotal parathyroidectomy the level of parathormone did not reach the recommended values for dialysis patients. In patients who underwent total parathyroidectomy, postoperative hypocalcemia was detected more often (p<0,05). The mean length of hospital stay was also higher in these patients (p<0,05). Laryngeal nerve paresis was detected in 2 (3,4 %) patients who underwent subtotal parathyroidectomy and 3 (11,1%) who underwent total parathyroidectomy.

Conclusion. Postoperative hypocalcemia was more common in patients who underwent a larger intervention. Subtotal parathyroidectomy was associated with more frequent recurrences of the disease. Total parathyroidectomy did not increase the risk of laryngeal nerve paresis.

Introduction. Surgical tactics and the direct choice of treatment for patients with gunshot wounds of the hand and forearm are important issues in hand surgery.

Materials and methods of research. A clinical study was conducted based on the treatment of 24 patients with gunshot wounds to the hand and forearm at the stage of providing specialized medical care. The study was conducted at the hospital stage and remote results were monitored.

Treatment results. The results of the study showed the high efficiency of using special software in the preoperative period in order to select the optimal surgical approach and further combat pain, swelling and improve microcirculation and, as a result, create favorable conditions for wound healing and reduce hospitalization.

Conclusion. The use of staged surgical treatment with elements of reconstructive surgery in choosing a method for the fastest possible cleaning of a contaminated wound and reducing the rehabilitation period. Programmed staged surgical treatment with elements of reconstruction of damaged anatomical structures made it possible to more effectively combat swelling and pain, create conditions for the fastest possible restoration of the function of the hand and upper limb as a whole, which are the main factors in the favorable course of the wound process. It was possible to reduce the average period of treatment and rehabilitation of the wounded from 5–6 to 3–4 months, which contributed to early social and labor adaptation.

Introduction. The nature of modern wars and armed conflicts has changed significantly, new types of weapons have begun to be used, and combat tactics have significantly transformed. It is obvious that in such conditions, the medical care must undergo significant changes and adapt to modern realities. It is required to develop new and improve existing forms and principles of assistance based on taking into account, analyzing and rethinking their positive and negative aspects. One of the possible ways to accelerate the adaptation of the domestic medical care system to new realities should be considered the possibility of applying a number of provisions formed and actively used abroad in the concept of “tactical medicine”.

Materials and methods of research. Based on the analysis of a number of publications by leading domestic and foreign experts, as well as existing guidance documents, material is presented that allows us to form or supplement the understanding of the concept of “tactical medicine”.

Results. The main problems of organizing and providing medical care to the wounded at the prehospital stage are identified, and possible ways to solve them are outlined.

Conclusion. Failure to follow the agreed-upon charters, norms, and principles regarding prohibited methods of warfare, as well as the use of indiscriminate and excessive methods of destruction by the combatants, has led to a change in the pattern of combat casualties among soldiers and an increase in civilian casualties. Under these circumstances, it is crucial to develop new and enhance existing methods and principles of medical care. It is also necessary to organize a systematic, continuous, and comprehensive education process that covers a wide range of individuals who are trained and capable of providing first aid to victims. The findings should be integrated into a modern medical support system.

Introduction. During military operations, not only military personnel but also civilians are injured. Injuries sustained by civilians have different localisations, and the pelvic organs are no exception.

Purpose of the study. To study the long-term results of treatment of pelvic gunshot wounds in women.

Materials and methods of research. A study of 100 female patients who had previously undergone pelvic surgery for gunshot wounds was conducted. The mean age of the subjects was 38 ± 5 years. Depending on the time of surgical treatment from the moment of injury, all the subjects were divided into two groups: A – patients who underwent surgical treatment up to one hour from the time of injury (50 patients) and B – patients who underwent surgical treatment more than one hour from the time of injury (50 patients).

Results. Out of the total number of those examined, the absence of complaints related to the previously undergone surgery was noted by 36 % of the respondents, while in the remaining 64 % of observations various complaints were identified, which can be conditionally divided into psychological complaints in 23 % of observations and complaints related to pain syndrome in 41 % of cases.

Conclusion. As the presented analysis shows, gunshot wounds of the small pelvis in women in the remote postoperative period are accompanied by quite a large number of complaints. However, it should be noted that the distribution of complaints depended on the time elapsed from the moment of wounding to the beginning of surgical intervention.

Introduction. One of the reasons for contacting a plastic surgeon is increasingly the overhang of the upper eyelid in combination with epicanthus. Due to increased migration processes, the number of upper blepharoplasty operations in combination with epicanthoplasty is steadily increasing from year to year. With the apparent simplicity of the operation, it has its own indications and contraindications, as well as rare, but still complications.

The aim of the study was to evaluate the immediate and long-term results of surgery and the incidence of complications in upper blepharoplasty and epicanthoplasty.

Materials and methods. The prospective study included 49 patients admitted to the clinic from 2021 to 2023. The age of the patients ranged from 25 to 34 years. All patients underwent a combined operation of upper blepharoplasty and medial epicanthoplasty.

Results. In the immediate postoperative period, complications occurred in 4 (6 %) people. After 6 months, at a follow-up examination, dissatisfaction with the result was noted in 1 patient. A clinical case is presented as an illustration.

Discussion. In the Russian Federation, especially in the European part, such operations are not so in demand, but their number is steadily growing. During the study, it was noted that the results of surgical treatment depend on the initial condition of the patient, both general and local.

Conclusions. The increase in the number of operations of upper blepharoplasty and epicanthoplasty in the Russian Federation requires further study of the problem, development of indications and contraindications and prevention of possible complications.

Introduction. One of the most difficult anatomical structures to restore during breast reconstruction is the inframammary fold. Inframammary fold is one of the most important elements of the natural manifestation of breast ptosis and an important structure that affects the aesthetic appearance of the breast during its augmentation and reconstruction, therefore, its restoration during breast reconstruction allows you to achieve an optimal aesthetic result, close to the natural appearance of the breast.

Materials and methods of research. In order to achieve the best aesthetic result, a method for preserving IC during subcutaneous and skin-preserving radical mastectomy has been developed and patented on the basis of the Oncosurgical Department of the A.I. Burnazyan FMBC. The article presents a clinical case of a patient in the course of whose treatment the method described above was used.

The results of the treatment. The development and implementation in practice of an easy-to-perform method of shrinkage and long-term fixation of the skin-fat cover after subcutaneous or skin-preserving mastectomy provided a solution to the problems associated with scar deformations of the cover during the rehabilitation period and adjuvant radiation therapy and preservation of inframammary fold.

Conclusion. The use of various methods that properly restore the inframammary fold is a necessary component to achieve an optimal aesthetic result of reconstructive surgery. The method developed and patented by us copes with this task, being an easy-to-implement and cost-effective method.

Introduction. Acute violation of arterial circulation of the upper extremities is a difficult problem in terms of surgical treatment. Among modern examination methods, duplex scanning of the arteries of the upper extremities is most often used. Contrast angiography has been and remains the absolute method of diagnosing arterial lesions. MSCT angiography is currently becoming a serious competitor to conventional vascular imaging methods.

A clinical case. The case of surgical treatment of patient S., 61 years old, who was taken to the general surgery department of Ramenskoye Hospital by an ambulance team with a clinic for acute ischemia of the right upper limb is presented. CT scan shows occlusion of the right axillary and right brachial arteries. Autovenous subclavian-brachial bypass surgery was performed.

Discussion. In the absence of the technical possibility of conducting a standard contrast examination of blood vessels, it is necessary to resort to MSCT angiography, which will help determine the true level of occlusion of the main vessel.

Conclusion. To establish the exact level of occlusion of the arteries of the upper extremities and to choose the correct method of surgical intervention, instrumental research methods, including radiopaque examination of the arteries, are necessary. In the absence of an angiography room, MSCT angiography is an important aid in the examination of the patient.

Introduction. Diagnostics and treatment of acute tissue hypertension syndrome (compartment syndrome) is one of the urgent problems of surgery.

Objective. To study the main available methods of tissue pressure control in patients with intermuscular phlegmon of the upper limb.

Materials and methods of research. The study included: analysis of available literature on the electronic resources CyberLeninka, Elaibrary, Google Academy. Analysis of the original material on the diagnosis of tissue hypertension in 134 patients with deep intermuscular phlegmon of the upper limb.

Treatment results. The clinical diagnosis of compartment syndrome is not always obvious. Usually, the patient may have a diffuse purulent process and it can be difficult to determine which localization causes pain. Today, there are two main types of determining the increase in pressure inside the fascial cases, these are hardware technologies and subjective signs. Both directions have an equal number of followers. In medical centers in America, the "five Pi" rule has become especially popular for diagnosing compartment syndrome. In Europe, Africa, Asia, surgeons prefer catheter systems operating on the Whitesides principle.

Conclusion. Hardware measurement of tissue pressure is the only adequate method for diagnosing tissue hypertension, has 100 % sensitivity, is accessible to medical institutions with different levels of funding, and should be recommended for widespread implementation in practice.

Introduction. Preoperative assessment of the risks of liver failure and the study of the process of reparative liver regeneration play a key role in choosing the scope of surgery. The study of the features of postresection liver regeneration will also allow us to assess the possibility and necessity of using regenerative medicine methods, including those based on the use of stem cells and gene therapy.

The purpose of the study. To analyze modern approaches to stimulation of postresection liver regeneration, to study the mechanisms of their effect.

Materials and methods of research. The data presented in PubMed, Elibrary and Cyberleninka are reviewed. Criteria for exclusion from the analysis: description of individual clinical cases; books and documents; comparison of treatment results of individual patients. The final analysis includes 52 works from the initially identified 105 sources.

Results. To date, there are several ways to influence liver regeneration: the ERAS technique, the study of the functional reserve of the liver, components of the hemostasis system, infusion therapy, correction of its own metabolites, regulation of signaling repair pathways. One of the most promising approaches is the use of multipotent stem cells.

Conclusion. The study and understanding of modern mechanisms for increasing the reparative potential of the liver will allow not only to perform extensive surgical interventions with fewer complications, but also to reduce the recovery time and disability of patients after such interventions.

Introduction. Patients who have undergone surgery for a pilonidal cyst, in the majority, belong to a young, able-bodied category of the population, and it takes a long time for the wound to heal, which significantly affects the economic aspect of treatment and quality of life of patients. The use of negative pressure wound therapy (NPWT) after excision of the pilonidal cyst may shorten the duration of disability, decrease the length of postoperative hospital stay, reduce the cost of treatment, and ensuring the speedy return of patients to their usual lifestyle.

Materials and methods of research. The systematic review was conducted in accordance with PRISMA guidelines. The literature search was carried out in PubMed and eLibrary databases.

Results. The meta-analysis included 6 studies (151 patients who underwent negative pressure wound therapy after excision of the pilonidal cyst and 150 patients who underwent local conservative therapy). Statistically significant differences were found in the reduction of the time of wound healing after the pilonidal cyst excision. The wound healing time after excision was significantly lower (M = 15 days; p < .00001) in patients who received negative pressure wound therapy.

Conclusion. The use of negative pressure wound therapy in patients after pilonidal cyst excision reduces postoperative wound healing time.

Introduction. Analysis of modern literature data made it possible to establish key clinical and biochemical parameters that determine the severity of acute pancreatitis. A comprehensive dynamic assessment of these indicators in patients with this pathology revealed their clear relationship with the progression of the disease and the development of complications.

Purpose of the study. To evaluate the dynamics of clinical and biochemical parameters as a criterion for the severity of acute pancreatitis.

Materials and methods of research. The work is methodological in nature. The work used theoretical and empirical methods: analysis of literary sources, generalization, systematization, classification. A meta-analysis of available literature sources was carried out, as well as their comparison with the results of our own research.

Treatment results. The increase in organ dysfunction, developing into multiple organ failure, the formation of destructive local changes in the pancreas, the aggravation of the systemic inflammatory reaction, impaired microcirculation and hemodynamics, as well as the addition of infectious complications are naturally associated with aggravation of the patients’ condition. In parallel with clinical manifestations, the progression of acute pancreatitis is accompanied by characteristic changes in biochemical parameters. There is an increase in markers of cellular and tissue damage.

Conclusion. A comprehensive analysis of the dynamics of clinical and biochemical parameters in patients with acute pancreatitis makes it possible to timely identify patients with a high risk of developing severe disease and complications, which necessitates a differentiated approach to diagnostic and treatment tactics.

Introduction. Postoperative hernias of the anterior abdominal wall present the most urgent problem in herniology today. Despite the use of modern techniques, the proportion of relapses is still high, ranging from 6,5 to 31 %. Many researchers suggest that one of the reasons for such a high recurrence rate is disorders in the structure of connective tissue and more and more attention is being paid to connective tissue dysplasia.

The purpose of the study. To update information on the role of connective tissue dysplasia in the formation of hernias of the anterior abdominal wall.

Materials and methods. A review of all available articles published on PubMed, Cochrane and Elibrary in Russian and English, containing the keywords: "collagenopathy", "dysplasia", "hernia", was conducted, as well as analyzed works that have a logical connection between the individual characteristics of connective tissue and the development of hernias of the anterior abdominal wall. A total of 125 literary sources were analyzed, 35 of the most relevant and cited are included in the list of references.

Results. Currently, a significant amount of information has been accumulated on the role of an altered type I/III collagen ratio in the skin and fascia of the anterior abdominal wall in the development (recurrence) of hernias. The analysis of existing methods of phenotypic assessment of nonspecific connective tissue dysplasia has shown the advantage of the technique of N.G. Luzgina and V.A. Shkurupiya for patients with postoperative hernias.

Conclusions. Further studies are needed to assess the effect of nonspecific connective tissue dysplasia on both the genesis of postoperative hernias and the results of surgical treatment using various modern techniques.

Introduction. Pre-hospital care in most cases takes a short period of time (sometimes only a few minutes) before more qualified personnel arrive on the scene. However, without first aid in this short period of time, the victim may lose the chance to survive in an emergency situation.

Purpose of the study: to consider the peculiarities of assistance at the pre-hospital stage in peacetime and wartime.

Materials and methods of research. The results of scientific studies devoted to the consideration of pre-hospital care in peacetime and wartime were studied. Various databases such as Scopus, Web of Science, MedLine, Science Direct, PubMed and eLIBRARY.ru were used for analysis. The search was performed, using keywords. Research methods included analytical analysis and summarization of data.

Results. The article analyzes the organizational aspects of prehospital care of the injured both in peacetime (in emergency situations) and in wartime. The experience gained over the centuries is analyzed and adapted to the special conditions of armed conflicts.

Conclusion. Organization of interaction is the main issue of the management system. Jointly conducted exercises with the medical service of the Ministry of Defense of the Russian Federation in the general structure of the All-Russian Disaster Medicine Service will undoubtedly allow to identify and more clearly specify the setting of goals, objectives, program of actions, indicators of the effectiveness of civil-military cooperation.

Introduction. The need for highly sensitive and highly specific markers of systemic inflammation (MI) in most emergency surgical diseases remains an urgent scientific and clinical task.

Results. The article is devoted to the description of the main characteristics of the most accessible MI used in abdominal diseases. Thus, in acute appendicitis, it is recommended to assess the level of C-reactive protein and procalcitonin not only for primary diagnostics, but also as a differential criterion between uncomplicated and complicated forms of the disease. The use of MI in patients with suspected acute cholecystitis is even more important than in other acute abdominal diseases, since early stratification of cohorts by disease severity is crucial for the timing and extent of surgical treatment in this patient population. The presence and varying severity of the aseptic inflammation phase, and especially the development of infected acute pancreatitis, leave no other options than to monitor not only vital functions in patients, but also the dynamics of MI concentration. Non-specificity of symptoms, wide variability of clinical and morphological manifestations of intra-abdominal inflammation formed the basis for recommendations on mandatory determination of the level of C-reactive protein in the blood serum of patients with acute diverticulitis.

Conclusions. Effective MI should be used in emergency abdominal surgery not only for early verification of the inflammatory genesis of the patient's painful condition, selection of the optimal therapeutic component, but also for prognosis, and especially for monitoring the course of the disease.

In the last 5 years, the number of scientific publications about mixed reality (MR) in surgery is significantly increased.

One of the component of MR is virtual reality (VR) technology, which has been used in medicine for training purposes since the end of the 20th century. MR replaced virtual reality (VR) and expanded the possibilities of using technology for surgical interventions, including the possibility of using it directly during surgery. In oncourological practice, MR is actively using for kidney resections, retroperitoneal and salvage lymphadenectomies.

The main way of using MR technologies in oncourology are partial nephrectomy, retroperitoneal and salvage lymphadenectomy.

We introduce literature review of using possibilities and results.

Today, much attention is paid to the study of microcirculation, since the processes occurring between microvessels and tissues are the end result of the functioning of the entire cardiovascular system. Microcirculation is the process of transporting biological fluids at the tissue level, which includes the movement of blood through capillary–type vessels, the movement of interstitial fluid and substances through intercellular spaces, the flow of lymph in the initial sections of the lymphatic bed. An urgent issue of modern medicine is the search for new diagnostic methods that can identify the smallest changes even at the preclinical stage. Therefore, the purpose of the article was to review the current literature in search of data on the use of capillaroscopy in clinical practice as an informative and accessible method for assessing the state of peripheral blood circulation. The use of capillaroscopy makes it possible to diagnose pathology already at the early stages of its development, but at the same time there is an insufficient number of studies.

The article examines the possibility of terminating an employment contract at the initiative of the employer in the event of bad-faith performance of job duties by a medical worker on certain grounds provided for in the Article 81 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code of the Russian Federation).

Introduction. The author outlines the general problem of the inability of medical organizations to terminate employment contracts with unscrupulous employees who are careless and negligent in their job responsibilities. The circumstances of termination of employment contracts with medical workers on some grounds of Article 81 of the Labor Code of the Russian Federation are analyzed. The formal approach of the courts in determining the grounds for termination of an employment contract at the initiative of the employer is shown. The need to provide a medical organization as an employer with the right to terminate employment contracts with unscrupulous employees is emphasized, taking into account the social significance of the medical care provided to citizens and the high level of responsibility of medical workers.

Conclusion. Based on the results of the analysis, it can be concluded that it is possible to amend current legislation in order to improve and maintain the quality of medical care at a high level, maintain patient confidence in medicine and increase the responsibility of medical workers.