Introduction. Patients suffering from acute pancreatitis are at high risk of serious cardiac complications. The effect of cardiodepression belongs to the category of potentially dangerous complications of acute pancreatitis.

The purpose of the study is to analyze the features of the relationship between the effect of cardiodepression and acute pancreatitis.

Materials and methods of research. We analyzed the results of pathological examination and histology of the heart of patients diagnosed with acute pancreatitis in the period from 2019 to 2023.

Treatment results. The results of our study showed that the second most common diagnosis was pancreatic necrosis – 10,8 % of patients. Chronic pancreatitis is in third place – 8,8 %. Patients have complications such as peritonitis, intoxication, various types of shock, phlegmon, peritoneal necrosis, which leads to death. The combined manifestation of peritonitis and intoxication led to severe multiple organ disorders, including impaired functioning of the cardiovascular system, and cardiodepression. A significantly significant correlation was found between the condition of the heart muscle tissues and the severity of edema. There was a direct correlation between tissue characteristics and the severity of edema.

Conclusions. The data obtained is approximately comparable to the data obtained by other authors. Uncontrolled release of proinflammatory cytokines into the systemic bloodstream in response to activation of proteolytic enzymes and tissue destruction in acute pancreatitis is a trigger mechanism for the formation of systemic inflammatory response syndrome. This process is accompanied by the development of pathological conditions, one of which is the effect of cardiodepression.

Introduction. Mechanical jaundice (MF) is the most severe complication of the pathology of the hepato-pancreato-duodenal zone. Despite the improvement in results due to the use of minimally invasive surgery, the mortality rate remains high.

Goal. To study the state of neutrophilic granulocytes by atomic force microscopy in patients with benign obstructive jaundice of varying severity.

Materials and methods. The polycentric study included 84 patients aged 41 to 64 years who were treated in hospitals in Krasnoyarsk with a diagnosis of obstructive jaundice of benign origin. The control group consisted of 60 donors. All patients were divided into 3 groups according to the severity of obstructive jaundice. The chemiluminescence of neutrophils and atomic force microscopy of neutrophil granulocytes were studied to determine the shape, state of the membrane, and adhesion forces.

Results. In patients with mechanical jaundice, the intensity of spontaneous chemiluminescence depends on the severity of mechanical jaundice. Atomic force microscopy revealed violations of the structural organization of the neutrophil granulocyte. As the severity of mechanical jaundice increased, the neutrophil acquired a convex shape, the number of nuclear segments increased, and the cell membrane became uneven. The magnitude of neutrophil adhesion forces decreased from 25 % to 31 %.

Discussion. Based on the analysis of the chemiluminescent activity of neutrophilic blood granulocytes, it can be concluded that the functional capabilities of cells in patients with breast cancer are depleted in parallel with an increase in the severity of breast cancer. This is accompanied by changes in the neutrophil itself.

Conclusion. As the degree of benign obstructive jaundice worsens, the number of neutrophilic leukocytes in the peripheral blood decreases and the number of lymphocytes increases. The intensity of spontaneous chemiluminescence also depends on the severity of breast cancer, and, accordingly, decreases as the degree of jaundice increases, which leads to depletion of the functional capabilities of neutrophils. This process is aggravated by changes in the shape of the neutrophil and its membrane. Together, this causes a decrease in the body's immune response and worsens the course of the disease.

Introduction.  Eliminating large postoperative hernias is a difficult task, and in patients with obesity, diabetes, and smoking, the risk of postoperative complications increases many times.

Study objective. To evaluate the results of treatment of postoperative ventral hernias in overweight patients by using a differentiated approach to the choice of hernioplasty method.

Materials and methods. The results of surgical treatment of 135 patients with postoperative ventral hernias in two medical institutions were studied. The first group (68 patients) underwent surgery using an endoprosthetic mesh, the second group (67 patients) underwent an autodermal transplant prepared in oxygenated preparations. Results. Multifactorial logistic regression analysis revealed no significant differences in the incidence of adverse events between the groups (OR = 0,834, 95 % CI [0,456–1,592], p = 0,687). However, there was a significant decrease in the incidence of seromas (7,35 % vs. 1,49 %, p = 0.004). Moreover, skin autotransplantation was associated with a decrease in the incidence of seroma (OR = 0,296, 95 % CI [0,097–0,931], p = 0,042).

Conclusion. Hernioplasty using deepithelized autoderm prepared preimplantatively in oxygenated preparations is suitable for the treatment of postoperative ventral hernias in obese patients (BMI ≥ 25 kg/m2), diabetes mellitus, as well as in patients at high risk.

Materials and methods of research. The work is a cross-sectional retrospective study. The medical records of the operated patients were analyzed. The first group consisted of 26 people operated according to the original method, the second group included 40 people operated according to the standard Frey surgical procedure.

Results. Among the complications in the early postoperative period, bleeding was most often noted: 30,8 % in the first group and 40,0 % in the second, while anastomosis failure was determined in 19,2 % and 20,0 %, abscess – in 7,7 % and 10,0 %, respectively. In the first group, 3,8 % of patients retained the symptoms of chronic duodenal obstruction after 9 months, while in the second group – in 20,0 %. The level of quality of life in patients 9 months after surgery was higher in the first group compared with the second.

Discussion. The advantages of the proposed technique are high efficiency in relieving pain, eliminating symptoms of duodenal compression, and preventing further development of duodenal obstruction while fully preserving the integrity and functions of the duodenum.

Conclusion. The proposed surgery technique has shown good early and long-term results in the treatment of chronic pancreatitis.

Introduction. The number of patients with hernias of the anterior abdominal wall is steadily increasing every year. Despite the introduction of new herniation techniques, the percentage of postoperative complications remains high.

Objective: to compare the long-term results of patients with and without rehabilitation.

Materials and methods. The polycentric study included 58 male and female patients who underwent hernioplasty of the umbilical hernia with a synthetic mesh prosthesis.  The methods of postoperative rehabilitation are described.

Results. According to the results of the study, it can be argued that the conducted postoperative rehabilitation helps to prevent the development of chronic pain syndrome. Prevention had no effect on the development of hernia recurrence.

Discussion. A modern approach to the timing and methods of rehabilitation after hernioplasty can significantly reduce the percentage of long-term postoperative operations and improve the patient's condition. At the same time, a necessary condition for the effectiveness of rehabilitation is the independent implementation of recommendations to patients at the outpatient stage of treatment for at least 2 months.

Conclusions. As the study showed, hernioplasty of the umbilical hernia with a mesh synthetic prosthesis followed by the proposed rehabilitation program suggests a significant improvement in long-term postoperative results. The number of patients included in the study and consideration of hernioplasty exclusively for umbilical hernias does not allow us to draw a global conclusion about the application of the described program to all patients after hernia repair. For such a statement, it is necessary to conduct additional research.

Introduction. Surgical treatment of rectocele by traditional methods (muscle plastic surgery and resection of stretched mucosa) is characterized by the risk of complications in the form of bleeding, suppuration, suture divergence (17–30 %), the frequency of relapses (5–35 %), unsatisfactory treatment results (5–85 %). It is characterized by technical complexity and duration of operations, low quality of life in the immediate postoperative period, long-term rehabilitation. These facts determine the need to search for new solutions in surgical tactics of the disease with improved results and increased treatment efficiency.

Purpose of the study. To study the efficiency and safety of a new method of surgical treatment of rectocele – combined laser correction of rectocele.

Materials and methods. Study group: 72 patients with lower anterior rectocele of 1–2 degrees. All patients were women aged 28 to 72 years. Exclusion criteria: severe concomitant pathology, purulent diseases of the anal canal. Most patients had concomitant hemorrhoids of stages 1, 2, 3, 4.

Surgical treatment was performed under intravenous anesthesia with the addition of local anesthesia. Laser radiation of a diode device with a wavelength of 1,56 mkm and a power of 10 W was used.

Results. Low (up to 5 points on VAS in 90 %) and short-term (taking NSAIDs 1–2 times a day for no more than 10 days in 90 %) postoperative pain syndrome. Rare complications (2 % of bleeding due to non-compliance, skin fringes). Satisfactory rehabilitation periods (30–40 days in 90 %). High quality of life in the immediate postoperative period. Low percentage of relapse during observation for 1 year (less than 5 %). High satisfaction with treatment (more than 95 %).

Conclusion. The method has significant prospects for use in patients with initial stages of lower rectocele. It is characterized by high efficiency and safety. It can be used in outpatient surgery. It has no significant limitations if the rules for selecting patients for treatment are followed. It is simple and fast in technical execution.

Introduction. Gallstone disease is highly prevalent in developed countries. This disease can lead to life-threatening complications such as obstructive jaundice, liver-kidney failure, and hepatic encephalopathy. Diagnosing, preventing, and treating hepatic encephalopathy is crucial, especially in the postoperative period. There are several theories regarding the development of this complication. A combination of diagnostic methods is used to identify it. The treatment uses agents aimed at reducing hyperammonemia, increasing the neutralization of ammonia in the liver, reducing inhibitory processes in the central nervous system, and hepatoprotectors. After a drainage operation on the bile ducts, in the postoperative period, the drug Succinic acid was used. This drug has a membrane-stabilizing, cytoprotective effect and improves the energy supply of cells. The aim of the study is to improve the results of treatment of patients with benign obstructive jaundice in the postoperative period after drainage operations.

Materials and methods of research. The first group of the study included patients who administered 400 ml of the studied drug in the postoperative period. The second group received 800 ml. Early diagnosis of hepatic encephalopathy and monitoring of the dynamics of the patients' mental state were carried out using the number connection test. The results were recorded in both groups on days 1, 3, 5, 8, and at the end of the study (days 12–16). The reliability of the obtained data was determined using the Mann-Whitney U-test.

Results. The assessment of the time required to complete the neurophysiological test of number association showed a decrease of 17 seconds in patients of the second group.

Conclusion. Patients who received a double dose of succinic acid in the postoperative period showed the best results in the neurophysiological test.

Introduction. Electrosurgical methods are widely used in general and endoscopic surgery, but their use is accompanied by the formation of so-called surgical smoke, which contains many toxic substances. In addition to the health effects of smoke, electrosurgery itself carries a number of characteristic risks. The presence of smoke in the surgical area impairs the visibility of the surgical field. In laparoscopy, this problem is aggravated by the confined space of the abdominal cavity.

The purpose of the study. To conduct a comparative analysis of the results of laparoscopic cholecystectomy using a protocol for safe operation with electrosurgical equipment and with active evacuation of surgical smoke, and without using this protocol.

Materials and methods. A comparative analysis of the results of laparoscopic cholecystectomy performed in 507 patients with chronic calculous cholecystitis at the surgical department in 2021-2024 was carried out. The patients were divided into two groups: the control group (n = 252) consisted of patients who underwent a standard laparoscopic cholecystectomy technique using an electrosurgical instrument without special smoke evacuation; The study group (n = 255) consisted of patients who underwent laparoscopic cholecystectomy performed using the author's protocol for safe operation with electrosurgical equipment and with active evacuation of surgical smoke.

Results. We have developed a checklist of measures for safe operation with electrosurgical equipment and with active evacuation of surgical smoke. The application of the developed protocol made it possible to increase the safety of the intervention for the patient.

Discussion. Our study shows that the introduction of a standardized protocol for safe electrosurgery with active smoke evacuation in CCE can simultaneously improve intraoperative conditions (visualization, coagulation control) and reduce the incidence of a number of complications without increasing the duration of the intervention.

Conclusion. The introduction of a protocol for safe operation with electrosurgical equipment with active evacuation of surgical smoke significantly improves the conditions for laparoscopic surgery. The author's protocol demonstrates a high level of safety for the patient and reduces the incidence of various postoperative complications, including burn injuries.

Introduction. In some patients with critical limb ischemia, direct revascularization is not feasible due to the absence of an adequate distal arterial bed (no-option).

The purpose of the study. To evaluate the effectiveness of revascularization using free muscle flap transfer in patients with critical lower limb ischemia of various etiologies.

Materials and methods of research. A retrospective analysis was conducted on 37 patients (10 with throm boangiitis obliterans [Buerger’s disease], 15 with diabetes mellitus, and 12 with atherosclerosis of the lower limb arteries) operated on between 2016 and 2025, who underwent lower limb revascularization using free muscle flaps (gracilis, latissimus dorsi).

Treatment results. The overall technical success rate was 62 % (23 of 37 patients): 90 % in the Buerger’s disease group, 75 % in the atherosclerosis group, and 33,3 % in the diabetes group. The one-year limb salvage rate was 88,9 %, 77,8 %, and 80 %, respectively, with an overall limb salvage rate of 82.6 %. The mean follow-up period was 29,7 months (M ± SD: 29,7 ± 24,9 months, n = 19), with the longest follow-up exceeding 9 years. The presence of neovascularization in tissues surrounding the transferred flap was confirmed histologically.

Conclusion. Indirect or combined revascularization using a free muscle flap is a valuable alternative to major amputation in no-option critical limb ischemia patients. Further research is warranted, particularly in diabetic patients.

Introduction. The mini-J sternotomy is a minimally invasive approach for aortic valve replacement. Despite its advantages, anatomical variability of the chest and the limited width of the operative field pose technical challenges. Morphometric standardization of the access geometry allows optimization of the balance between adequate surgical exposure and preservation of sternal stability.

Objective. To evaluate the morphometric parameters of mini-J sternotomy in aortic valve replacement.

Materials and methods. The study included 45 patients who underwent mini-J sternotomy in 2023–2024 at Sechenov University. Intraoperatively, the following parameters were measured: length of the vertical (Lᵥ) and horizontal (Lₕ) limbs of the incision, bend angle (α), depth of the J-curve (D), intercostal level of intersection (U), width of the operative window (W), and exposure index (EI = Aₚ/Sₛ). Correlation analysis was performed between morphometric parameters and clinical outcomes, including myocardial ischemia time, cardiopulmonary bypass duration, and blood loss.

Results. Mean values were: Lᵥ = 66 ± 5 mm, Lₕ = 37 ± 4 mm, α = 108 ± 7°, D = 22 ± 3 mm, W = 60 ± 6 mm, EI = 0,72 ± 0,06. No conversions to full sternotomy occurred. Exposure index correlated with the lengths of the vertical (r = 0.61) and horizontal (r = 0.54) limbs. Lᵥ < 60 mm was associated with an 11 ± 4 min increase in ischemia time, α > 120° with higher risk of microfractures, and D > 28 mm with sternal instability.

Conclusion. Mini-J sternotomy with parameters within recommended ranges provides optimal aortic root exposure, minimizes tissue trauma, and enhances procedural safety.

Introduction. Mini-J sternotomy is a minimally invasive alternative to conventional median sternotomy for aortic valve replacement. In elderly patients with a pronounced comorbid background, the safety and reproducibility of this approach remain debatable.

Objective. To evaluate the early outcomes of mini-J-sternotomy for aortic valve replacement in elderly patients (≥ 65 years) compared with younger patients.

Materials and methods. This retrospective single-center study included patients who underwent isolated aortic valve replacement via mini-J sternotomy. Two groups were formed: Group 1 – elderly patients aged 65–75 years, and Group 2 – patients aged 50–60 years. Propensity score matching was applied to ensure group comparability, taking into account demographic and clinical factors. After matching, two balanced cohorts of 20 patients each were obtained. Intraoperative parameters and early postoperative outcomes were assessed.

Results. The mean age was 69,2 ± 3,1 years in Group 1 and 55,6 ± 2,9 years in Group 2. The EuroSCORE II risk was higher in elderly patients (4,1 ± 1,2 % vs. 2,3 ± 0,8 %, p < 0.01). Operative time was 238 ± 27 min in Group 1 and 234 ± 22 min in Group 2 (p = 0,48), cardiopulmonary bypass time was 126 ± 15 and 121 ± 13 min (p = 0,31), and aortic cross-clamp time was 85 ± 9 and 79 ± 11 min (p = 0,12), respectively. Blood loss was 415 ± 95 and 398 ± 88 mL (p = 0,54). There were no conversions of access or in-hospital deaths. Postoperative atrial fibrillation occurred in 4 (20 %) patients in Group 1 and in 3 (15 %) patients in Group 2. Re-exploration for bleeding was required in 1 (5 %) elderly patient. Pneumonia occurred in 1 (5 %) patient in each group, and acute kidney injury in 1 (5 %) patient in Group 1. The duration of mechanical ventilation was 7,4 ± 1,2 h in Group 1 and 7,1 ± 1,3 h in Group 2, ICU stay was 1,5 ± 0,7 and 1,3 ± 0,6 days, and total hospital stay was 13,2 ± 2,1 and 12,7 ± 1,8 days, respectively (p = 0,62). A correlation was found between age and operative time (r = 0,32, p = 0,05), as well as between EuroSCORE II and cardiopulmonary bypass time (r = 0,36, p = 0,03).

Conclusion. Mini-J sternotomy for aortic valve replacement in elderly patients provides early outcomes comparable to those in younger patients and is not associated with an increased rate of complications, longer mechanical ventilation, or prolonged hospitalization, despite a higher preoperative risk.

Introduction. In accordance with the Russian National Clinical Guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities, ultrasound is recommended for regular monitoring of the vascular reconstruction area in the postoperative period, with a frequency of every six months.

The purpose of the study. To evaluate the immediate results of arterial reconstructions of the infrainguinal segment using ultrasound.

Materials and methods. The work is based on the results of an examination of 203 patients with atherosclerosis of the arteries of the lower extremities who underwent open and hybrid arterial reconstructions on the infrainguinal segment in the Department of Vascular Surgery of the N.I. Pirogov State Clinical Hospital No. 1 in 2025. All patients (n=203, 100 %) underwent a control ultrasound scan of the arteries of the lower extremities and the vascular reconstruction zone on the day after surgery. An expert ultrasound examination with the determination of velocity parameters in the area of vascular reconstruction, proximal and distal to it, was performed in 167 cases (82,3 %).

Research results and discussion. On the 1st day of the subcutaneous period, the arterial reconstruction zone was completely passable in 198 patients (97,5 %). Shunt thrombosis was diagnosed in 5 cases (2,5 %) after FPB, including in combination with BAP of the arteries of the legs. All patients underwent thrombectomy from the femoral-popliteal shunt, supplemented by: – Reconstruction of the arteries of the tibia (in 2 cases); – BAP with EIA stenting (in 1 case); – BAP with stenting of the distal anastomosis of FPB and PA (in 1 case); – EAE from CFA and DFA (in 1 case).

Residual hemodynamically significant stenoses in the iliac segment were detected in 6 patients (2,9 %). At the same time, the ratio of intravenous peak systolic blood flow velocity to prestenotic in these patients ranged from 3,3 to 3,9. All patients underwent iliac segment stenting in order to prevent early vascular thrombosis. Residual hemodynamically insignificant stenoses on both the iliac and infra-lingual arterial segments were detected in 12 patients (5,9 %). At the same time, the ratio of intravenous peak systolic blood flow velocity to prestenotic in these patients ranged from 2,1 to 2,9. In order to prevent early thrombosis of vascular reconstruction, all patients were prescribed dual antiplatelet therapy (Aspirin + Clopidogrel) or monotherapy (Aspirin) in combination with Rivaroxaban 2,5 mg x 2 r/ day.

Conclusion. In order to evaluate the arterial reconstruction performed on the infrainguinal segment, identify residual changes and residual defects in the arterial bed for the subsequent prevention of postoperative thrombosis, in the early postoperative period, it is recommended to perform an expert ultrasound examination to determine the velocity parameters in the area of vascular reconstruction, proximal and distal to it, assessment of the morphological substrate of arterial lesion, the ratio of peak systolic blood flow rate (intravenous to prestenotic).

Introduction. Differential diagnosis of lung lesions in individuals living with HIV presents significant challenges, as the clinical, radiological, and laboratory findings for various diseases are nonspecific, requiring morphological verification in some cases.

The purpose of this study is to study the feasibility and safety of diagnostic lung surgery in HIV-infected patients with varying immune status.

Materials and Methods. From 2014 to 2023, 404 diagnostic surgical interventions were performed to verify the diagnosis at the Department of Phthisiology of the Kemerovo State Medical University of the Russian Ministry of Health, using clinical data from the I.F. Kopylova Kuzbass Clinical Phthisiopulmonology Medical Center and the Moscow Scientific and Practical Center, including 111 in HIV-infected individuals.

Results. The examination of surgical material allowed us to establish a definitive diagnosis in all 404 patients (100 % success rate). In the study group (HIV+), tuberculosis was the predominant disease, accounting for 69 (62,2 %) cases. Among non-tuberculous diseases (42 patients, 37,8 %), the most common were non-tuberculous mycobacterioses (21,4 %) and non-specific pleurisy (21,4 %). Sarcoidosis accounted for 11,9 % of cases, and lung cancer, up to 14,3 %. In the control group (HIV–), tuberculosis was diagnosed in 141 (48,1 %) patients. Among non-tuberculous processes (152 patients, 51,9 %), lung cancer (34,2 %) and sarcoidosis (17,8 %) predominated.

Conclusion. Modern surgical procedures for diagnosing chest diseases are safe for patients with HIV infection and highly effective for establishing a definitive diagnosis, which is critical for appropriate treatment.

Introduction. Approximately 90 % of liver tumors are metastatic, predominantly from colorectal cancer (CRC). Only 10–25 % of such metastases are resectable. The median survival is less than a year without treatment and even with chemotherapy it does not exceed 18 months. The aim of the study to improve the effectiveness of treatment for patients with colorectal cancer liver metastases using minimally invasive local destruction methods.

Materials and methods of research. The study included 257 patients with CRC liver metastases (2002–2024). All patients underwent ultrasound, contrast-enhanced MRI/CT, PET-CT, and 3D modeling (MYRIAN XP-Liver) for treatment planning. All patients received combined therapy: chemotherapy according to FOLFOX/XELOX/FOLFIRI regimens ± targeted therapy.

Transarterial chemoembolization (TACE): 34 patients (to shrink tumors >4 cm). Radiofrequency ablation (RFA): 121 patients (tumors 1–5 cm). Microwave ablation (MWA): 57 patients (tumors 1–3,5 cm). Laser ablation (LA): 45 patients (tumors 1–3,3 cm).

Treatment results. Survival in the RFA group: 1 year – 73,5 %, 2 years – 53,3 %, 3 years – 32,1 %. MWA: 1 year – 78,5 %, 2 years – 63,3 %, 3 years – 58,3 %. LA: 1 year – 88 %, 2 years – 71 %, 3 years – 43,5 %. Median relapse-free survival is 8,5 months. The 1-year survival rate in the subgroup of 12 patients was 84 %. Mortality was 0,6 % (2 cases in the RFA group). The average hospital stay was 7 days.

Conclusion. The use of minimally invasive thermodestruction methods (RFA, MWA, LA) within a multidisciplinary approach significantly expands treatment indications for non-resectable patients (with severe comorbidities, bilobar involvement, low functional liver reserve). This increases overall resectability to 35–40 %, reduces surgical risks and the number of complications, shortens hospitalization times, and improves survival rates.

Introduction. To develop a nomogram and a preoperative risk calculator for predicting prolonged pleural effusion (PPE) in patients undergoing lobectomy for lung cancer, aimed at early prevention of this complication.

Materials and methods. The study was conducted at the Thoracic Oncology Surgery Department of the Regional Oncology Dispensary in Ulyanovsk, Russia. It included patients who underwent lobectomy between January 1, 2023, and January 1, 2025 (State Registration Certificate № 2025621960 for the database). A total of 215 patients were analyzed, of whom 115 did not develop PPE and 100 experienced the complication. After statistical analysis, bootstrap resampling was applied and logistic regression calibration was performed using artificial intelligence-based machine learning techniques.

Results. The incidence of prolonged pleural effusion was 100 out of 215 patients (46,5 %). Multivariate analysis identified significant predictors: preoperative white blood cell, neutrophil, and lymphocyte counts; Tiffeneau index; and video-assisted thoracoscopic access. The developed predictive model demonstrated high sensitivity (85 %) and specificity (61,7 %).

Conclusion. The incidence of prolonged pleural effusion in this study was 46.5 %. A predictive model and interactive risk calculator for PPE following lobectomy have been developed.

Introduction. To identify early clinical, functional and pleural predictors of prolonged pleural effusion (PPE) after lobectomy and to assess their prognostic value.

Materials and methods. This prospective single-centre study included 168 patients who underwent lobectomy with systematic mediastinal lymph node dissection at the Ulyanovsk Regional Oncology Dispensary between 1 June 2024 and 1 November 2025. Clinical and demographic data, pulmonary function parameters, complete blood count and biochemical markers, as well as pleural fluid characteristics on postoperative days 2 and 4–5 were analysed. PPE was defined as the need to maintain a pleural drain for more than 5 days in the absence of purulent complications. Logistic regression and ROC analysis were used for statistical assessment.

Results. The incidence of PPE was 29,2 % (49/168). In univariate analysis, taller height (p=0,012), smoking (p=0,002), higher peak expiratory flow (PEF) and forced vital capacity (FVC, % predicted), as well as increased pleural protein, neutrophil and lymphocyte counts and higher pleural fluid volume on day 2 (all p<0,001) were associated with PPE. In multivariable logistic regression, independent predictors of PPE were pleural neutrophil count on day 2 (AOR=1,94), pleural protein concentration (AOR=1,082), smoking (AOR=2,92) and FVC (% predicted) (AOR=1,021), whereas peripheral lower limb atherosclerosis was associated with a reduced risk of PPE (AOR=0,34). The resulting model demonstrated high discriminative ability (AUC=0,832; 95 % CI: 0,756–0,908; sensitivity 70,8 %; specificity 83,6 %).

Conclusion. Prolonged pleural effusion after lobectomy occurs in nearly one-third of patients and is strongly related to early markers of inflammatory exudative response in the pleural space, smoking status and functional respiratory characteristics. Early assessment of pleural fluid composition and key clinical parameters on postoperative day 2 allows reliable risk stratification for PPE and may guide individualized postoperative drainage management and clinical surveillance.

Introduction. Patients with metastatic gastric cancer and a history of gastric resection represent a distinct clinical subgroup at high risk of developing severe nutritional deficiencies, electrolyte disturbances, and decreased quality of life. Immunotherapy (IT) with immune checkpoint inhibitors (ICIs), despite its effectiveness in patients with PD-L1+ or MSI-H status, may worsen metabolic and electrolyte disturbances. At the same time, comprehensive rehabilitation, including nutritional support, physical activity, and psychological assistance, can not only correct these disorders but also improve quality of life and tolerance to therapy.

The aim of this study was to compare clinical manifestations, quality of life and electrolyte status in patients with metastatic gastric cancer after resection receiving IT, taking into account the use of comprehensive rehabilitation.

Materials and methods. A prospective randomized controlled study included 84 patients with histologically confirmed metastatic gastric cancer and a history of gastric resection (gastrectomy – 62, subtotal resection – 22). All patients received pembrolizumab or nivolumab. Groups: IT + comprehensive rehabilitation (n = 41) and IT (n = 43). Assessment was performed at study inclusion and after 6 months using the PNI, NRS-2002, EORTC QLQ-C30 scales, as well as laboratory parameters (Ca², Mg², nitrogen balance).

Results. After 6 months, the experimental group showed a significant improvement in PNI (56,2 ± 4,3 vs. 26,5 ± 3,2; p < 0,001), normalization of nitrogen balance (+5,2 ± 2,7 vs. –3,1 ± 2,3; p = 0,03), an increase in the level of Ca² (2,31 ± 0,14 vs. 2,05 ± 0,17 mmol/l; p < 0,05) and Mg² (0,87 ± 0,11 vs. 0,70 ± 0,13 mmol/l; p < 0,05). Quality of life according to the EORTC QLQ-C30 improved significantly: physical functioning (+14,8 %), emotional (+12,1 %), overall quality of life (+15,2 %; all p < 0,05). In the control group, a deterioration in all parameters was observed. The incidence of immune-mediated adverse events (IMEs) of grades 1–2 tended to decrease in the experimental group (e.g., hepatotoxicity – 2,4 % vs. 3,5 %). No IMEs of grade ≥3 were detected.

Conclusion. The obtained data confirm that in patients with metastatic gastric cancer and a history of resection, complex rehabilitation against the background of IT significantly improves nutritional and electrolyte status, reduces symptomatic burden and improves quality of life. The results substantiate the need for early inclusion of rehabilitation programs in the standards of care for this category of patients.

Introduction. Cutaneous melanoma remains a significant problem in modern oncology in Russia and many countries worldwide. According to the global cancer registry data for 2022, 331,722 new cases of skin melanoma were recorded, of which 3,9 % were patients from the Russian Federation.

Objective. To evaluate the diagnostic value and safety of sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) fluorescence mapping in patients with clinically localized stages of trunk and extremity melanoma.

Materials and methods. A single-center prospective study included 62 patients with clinically localized stages of trunk and extremity melanoma (cT1-4N0M0, ECOG 0-1) who underwent wide excision of the skin tumor with sentinel lymph node biopsy (SLNB) using ICG fluorescence mapping. To exclude loco-regional recurrence and other types of progression after radical surgery, patients underwent follow-up examinations every 3–6 months depending on the disease stage.

Results. Lymph nodes were identified in all 62 patients (100 %). This method demonstrated high diagnostic value: sensitivity – 100% and specificity – 100 %. Immunohistochemical (IHC) examination revealed the presence of metastases in sentinel lymph nodes in 9 (14,5 %) patients, and their absence in 53 (85,5 %) patients (pN0).

Notably, follow-up examinations of patients with no metastatic lymph node involvement pN0 ("SLNB-") showed no signs of loco-regional recurrence. During follow-up examinations at 6 months, loco-regional recurrences were detected in 2 (3,2 %) patients, and distant metastases were detected in 1 (1,6 %) patient 18 months after surgery; all these patients had pN1 ("SLNB+").

In a subset of patients with histologically negative results, extended pathological examination (ultrastaging) was performed, which revealed additional micrometastases in only 2 (3,2 %) patients. This finding did not change the clinical stage and showed no correlation with recurrences during the follow-up period.

Conclusion. Thus, in clinically localized stages of trunk and extremity melanoma, SLNB with ICG fluorescence mapping is not only safe but also represents a highly effective diagnostic method that enables timely and accurate staging of cutaneous melanoma with personalized treatment selection and further oncological follow-up. This approach ensures high precision of surgical intervention and minimization of its extent on regional lymph collectors.

Introduction. Purulent-necrotic diseases of soft tissues (PNDST) remain a challenging problem in purulent surgery with a mortality rate of 25–50 %. The method of local negative pressure wound therapy with instillation (NPWT-i) is a modern standard for treating complex wounds. The use of chymotrypsin within the NPWT-i framework overcomes the shortcomings of traditional enzyme therapy due to controlled delivery and rapid evacuation of lysis products.

Objective: To analyze the efficacy of the method of local negative pressure wound therapy with instillation of chymotrypsin compared to the use of physiological saline in patients with PNDST of the trunk and limbs.

Materials and methods. The study included 27 patients with PNDST of the trunk and limbs. In group 1 (n=15), NPWT-i with chymotrypsin was applied; in group 2 (n=12) – NPWT-i with physiological saline. The groups were comparable in terms of baseline characteristics.

Results. In group 1, significantly lower levels of leukocytosis and C-reactive protein (CRP) were noted on days 3 and 7 (p<0,05). According to digital planimetry data, by day 7 in group 1, the area of necrosis and fibrin was significantly smaller, and the area of granulation tissue was larger (p<0.05). Clinical outcomes in patients of group I were also better in terms of the number of secondary surgical debridements (3 [2;3] vs 4 [3;5], p=0,015) and the duration of hospitalization (21 [16;25] vs 31 [21;33] days, p=0,013).

Conclusion. The use of the method of local negative pressure wound therapy with instillation (NPWT-i) of chymotrypsin solution is an effective tool in the comprehensive treatment of patients with purulent-necrotic diseases of soft tissues of the trunk and limbs.

Introduction. Over the past few years, the structure of emergency medical care has seen an increase in the number of patients urgently admitted to hospitals with injuries as a result of road accidents. The work is based on data from the analysis of cases of hospitalization in Moscow of victims with the participation of means of individual mobility for 2023.

The goal. To determine the clinical and diagnostic features of providing assistance to victims with chest and abdominal injuries as a result of an accident using means of individual mobility by optimizing the algorithm of diagnosis and treatment.

Materials and methods. In the course of the work, a retrospective analysis of the 1954 maps of the victims was carried out, according to the results of which the main circumstances of injuries and their features were determined.

Results. It was revealed that injuries involving personal mobility aids are seasonal in nature, due to weather conditions and the work schedule of kicksharing companies. The main percentage of requests falls on summer time and weekends. In most cases, the injuries are combined, which requires an integrated approach to the diagnosis and treatment of victims. At the same time, among the injuries to the chest and abdomen, the main part is superficial.

Discussion. Given the growing popularity of SIM, the nature and prevalence of injuries, the urgency of the problem is only increasing today. However, given the growing popularity of personal mobility aids and the increase in injuries, the problem remains relevant and requires the development of universal diagnostic and treatment algorithms. 

Conclusions.  The frequency of chest and abdominal injuries in the structure of "SIM injuries" is 6,1 %. The main chest injuries are superficial injuries, rib fractures, hydro- and pneumothorax. The main injuries to the abdomen are superficial abdominal injuries, as well as injuries to parenchymal organs.

Introduction. Currently, there is a classification of gunshot wounds, according to which such wounds are divided into bullet, shrapnel, and mine-explosive wounds. The severity of such injuries is determined by several factors, the main of which is the high lethality due to kinetic energy, and the damage to the spleen can reach up to 19 % in such cases. It is evident that the nature of combat weapons has evolved over time, leading to changes in the nature of internal organ damage, which requires further research into this issue.

The purpose of this study the aim of this study was to examine the immediate postoperative period in a comparative aspect in various gunshot wounds of the spleen. Materials and methods. The study included 27 patients with gunshot wounds to the abdomen, accompanied by spleen injuries, who were divided into two groups: group A – gunshot wounds to the spleen, 15 (55,5 %) cases, and group B – shrapnel wounds, 12 (44,4 %) cases.

Research results and discussion. The presented study shows that gunshot wounds to the abdomen with damage to the spleen are accompanied by a fairly high percentage of complications – 51,8 % of cases, as well as a significant percentage of fatal outcomes – 29,6 %. At the same time, bullet wounds are accompanied by a higher percentage of complications compared to shrapnel wounds, respectively, 37,0 % and 29,6 %, and the number of fatal outcomes is 22,2 % and 7,4 %. The main complications recorded in the group of patients with abdominal gunshot wounds and spleen damage were purulent-septic, and the cause of death was shock.

Conclusion. Gunshot wounds to the abdomen, accompanied by damage to the spleen, are associated with worse outcomes in the immediate postoperative period compared to shrapnel wounds.

Introduction. In today's world, medical students are constantly under high academic pressure and stress. Psycho-emotional stress that occurs during studies can negatively affect the health of the visual organ, which makes it relevant to study the relationship between academic workload and the psycho-emotional state and visual acuity of students.

Objective. To study the impact of academic load on the psycho-emotional state and visual acuity of medical university students. 

Materials and methods. A longitudinal study was conducted among a group of medical university students. A total of 178 students were examined in their first year, of whom 101 were re-examined in their fourth year. The assessment was completed after the winter exam session. Visual acuity was determined without and with correction. Psycho-emotional state was assessed using the Beck Depression Scale and the Gissen Somatic Complaints Questionnaire. Results. Visual acuity declines among medical students as they progress through their fourth year (visual acuity 1.0 in 54,5 % of first-year students and 42,6 % of fourth-year students). The percentage of students without depression decreased from 35,4 % to 22,8 %, while the number of students with moderate to severe depression increased. Subjective visual impairment was also noted during periods of severe stress (29,4 % of first-year students and 35,5 % of fourth-year students).

Conclusion. Increasing academic load increases psycho-emotional disorders, which is one of the causes of decreased visual acuity in medical students. In the process of learning, it is necessary to introduce measures of psycho-emotional support and permanent control of visual acuity.

Introduction. Chronic osteomyelitis is medical and social problem. This pathology accounts for up to 28 % of purulent–septic diseases, in 60 % of cases leads to disability. Despite the many treatment methods, recurrence of chronic osteomyelitis is noted in 4–548 % of cases.

The purpose of the study. Improving the effectiveness of treatment of chronic experimental osteomyelitis through the use of a biological matrix with growth factors.

Materials and methods. The study was conducted in 5 groups: 3 control groups and 2 experimental groups. In 1st control group, no treatment was performed. Surgical rehabilitation was performed in 2nd control group and all subsequent ones. In 3rd experimental group, after sanitation, the defect was filled with amikacin and hydroxyapatite. Maral antlers were used in 1st experimental group. In 2nd experimental group, a combination of maral antlers and amikacin was used. The effectiveness of the technique was evaluated on days 7, 14, 28, 60, and 90 after surgical treatment.

The results of the study. In 2nd experimental group, there was a pronounced positive dynamic of the indicators of the general blood test, the least activity of oxidative stress and an adequate increase in SOD and Sh-groups. Indicators in this group normalized by the 90th day and had significantly better results compared to the control groups.

Conclusion. The optimal way to treat experimental chronic osteomyelitis is a two-stage surgical rehabilitation and filling of the defect with antibiotic amikacin and maral antler, in a mass ratio of 2/1. The application of the developed method not only helps to reduce the indicators of inflammation syndrome, but also to relieve oxidative stress by activating the systems of enzymatic and non-enzymatic protection systems.

On October, 2025, the 16th Congress of the Russian Society of Surgeons, along with the 10th Congress of Moscow Surgeons, was held in the Congress

Hall of the International Trade Center on Krasnaya Presnya. The congress traditionally featured a section on the history of surgery for the 10th time.

The first session of the section was devoted to the history of Moscow surgical schools, clinics, and departments. Presentations were made about the surgical school of Professor Yu. M. Pantirev, about the school of surgery of portal hypertension of the Russian Scientific Center of Surgery named after B.V. Petrovsky, about the Clinic of Faculty Surgery № 1 named after N.N. Burdenko of the First Moscow State Medical University named after I.M. Sechenov (Sechenov University), about the Faculty Surgery Chair № 1 named after V.S. Savelyev of the Institute of Surgery of the Russian National Research Medical University named after N.I. Pirogov (Pirogov University), about the Surgical Diseases Chair of the Faculty of Dentistry with the Clinical Angiology Course at the Russian University of Medicine, about the surgical service at Botkin Hospital, and the Chair of Surgery at the Russian Medical Academy of Postgraduate Education, and Professors G.I. Lukomsky and E.V. Lutsevich. The second session of the section featured reports dedicated to the 215th anniversary of N. I. Pirogov: about the lifetime bibliography of the great Russian surgeon, about his contribution to normal, pathological and topographic anatomy, angiology and vascular surgery, about the perpetuation of the memory of N.I. Pirogov in sculpture, on N.I. Pirogov's scientific school and new vision of his anatomical dissections. The presentations generated great interest among surgeons and medical historians.

Introduction. Combined infectious defects of bone and soft tissues represent one of the most difficult problems of modern clinical practice. Despite the development of innovative strategies, understanding of the pathogenesis and mechanisms of antibiotic resistance, the effectiveness of their treatment remains unsatisfactory. The use of low-intensity laser radiation is considered as a promising direction in the local treatment of soft tissue and bone infections.

The purpose of the study. To substantiate the tactics of choosing a photosensitizer for laser photochemical debridement (LPD) for the treatment of soft tissue and bone infections.

Materials and methods. The analysis of scientific literature presented on PubMed, eLibrary, MEDLINE, ScienceDirect is carried out. The study is planned to include data from 2015–2025. However, due to insufficient information, it was decided to expand the study to include data from 2005–2025. Results. LPD is highly effective in the complex treatment of soft tissue and bone infections. The effect on biofilms and bacterial metabolism makes this method especially relevant for persistent forms of chronic infection. The tactics of choosing FS for photochemical exposure includes several stages: assessment of the patient's contraindications to the use of FS; identification of the pathogen in the focus of infection; selection of a laser radiation source with the required wavelength.

Conclusion. Thus, the use of LPD is an effective method of combating infection of soft tissues and bones. The use of LPD makes it possible to shorten the duration of treatment, reduce relapses and improve the quality of life of patients.

Introduction. Secondary lymphostasis (lymphedema) is a consequence of impaired lymphatic drainage from the limb due to various causes. An increase in the incidence of breast cancer leads to an increase in severe lymphostasis requiring surgical correction. Erysipelas is traditionally distinguished among the causes of lymphostasis of the lower extremities, causing persistent lymphedema that does not respond to conservative therapy, as well as malignant diseases of the genital area in men. The increase in patients with lymphedema requiring surgical correction necessitates the search for new ways to restore patency of the lymphatic pathways.

Materials and methods. The search for literary sources was carried out in the PubMed and eLibrary databases.

The main part. New protocols for X-ray contrast studies with the search for new areas of lymph insertion and drainage are proposed.  One of the most effective methods is fluorescence lymphography. Ultrasound is widely used to determine the condition of lymph nodes. The article discusses various methods of applying lymphovenous anastomoses, advantages and disadvantages, and the number of shunts applied. The issues of preventive lymphovenous bypass surgery and lymph node transplantation are discussed.

Conclusion. Lymphovenous anastomosis is the method of choice in the treatment of lymphedema. With the functioning of the shunt, patients note a subjective improvement, a significant decrease in the volume of the limb. Most studies confirm the effectiveness of this method in the long term. The issues of preventive lymphovenous anastomosis and lymph node transplantation require further consideration.

Introduction. The neuropathic form of diabetic foot syndrome remains one of the most complex and prognostically unfavorable complications of diabetes mellitus. Chronic tissue hypoxia and bacterial contamination of the wound are key pathogenetic factors that lead to impaired reparative processes, infectious complications, and amputations.

The purpose of the study. Analysis of the available literature on the use of certain methods of local wound treatment in the neuropathic form of diabetic foot syndrome.

Materials and methods. Available foreign and domestic literature, scientific databases PubMed, e-library, Google Scholar.

Results. A literature review on the use of certain methods of local wound treatment in the neuropathic form of diabetic foot syndrome has been performed.

Conclusion. There are no studies on the combined use of local wound treatment methods, taking into account the phase of the wound process in the neuropathic form of diabetic foot syndrome.

Introduction. Anastomotic leak after low anterior resection (LAR) is a life-threatening complication. Preventive stoma formation is the primary method of prevention, but is associated with decreased quality of life and the need for reoperation. Objective: To compare the outcomes of LAR with total mesorectumectomy (TME) with and without a preventive stoma in patients with a low initial risk of leakage.

Materials and methods. This multicenter RCT included patients with rectal cancer who underwent laparoscopic LAR with TME at a low risk of leakage. The study group consisted of patients without stoma formation, while the control group consisted of patients with similar characteristics but with a preventive ileostomy or transverse ileostomy.

Discussion. The advisability of a stoma in low-risk patients remains unresolved. A protocol for a multicenter RCT, the RELOAD-trial, was developed to investigate this issue.

Conclusion. The results will show the incidence of leaks, immediate outcomes, quality of life, and the incidence of ileostomy syndrome in the compared groups.

Introduction. Fibro-sclerotic changes in the thyroid gland during minimally invasive interventions, particularly chemical ablation, are a targeted and planned outcome that determines the structure, size, and morphology of the destroyed areas of the gland. Changes in the size and volume of cysts, nodules, and thyroid tumors as a result of the use of chemical reagents are an expected outcome of induced progressive fibrosis and sclerosis of the tissues, which manifest as a decrease in the size of the focal lesion and a change in its pathomorphological characteristics.

Purpose of the study. To evaluate, according to the literature data, the indications for the use of the chemical ablation technique, the variants of its application, the dynamics of changes and the outcomes of fibrosclerotic changes in the tissue and nodular formations of the thyroid gland of various morphological structure.

Materials and methods. Search for literature sources in the E-library, PubMed, and Scopus databases using the keywords “fibrosis”, “sclerosis”, “calcification”, and “hyalinization” in conjunction with the phrases “sclerotherapy for thyroid pathology” and “chemical ablation for thyroid pathology”.

Results. When using the minimally invasive treatment method of "chemical ablation" in patients with thyroid pathology, the expected result is the regression of the focal formation and the progressive replacement of the proliferating thyroid tissue with fibrosis, sclerosis, hyalinosis, and calcification.

Conclusion. Today, chemical ablation is one of the components of the therapeutic algorithm for treating patients with thyroid pathology.