The  OBJECTIVE  is  to  estimate the  immediate and  long-term   results of  palliative  surgical   correction of  the  respiratory failure (RF) depending on the  variants of emphysematous lesion  of   the  lungs.  MATERIAL AND METHODS.  175  patients with  the  severe  pulmonary emphysema  (PE)  were  operated, 111  resections of  large  and  giant  bullas  (RB)  (55.5  %), 85  lung  volume   reduction surgery  (LVRS)  (42.5  %)  were   performed,  the  proportion   of  repeated  interventions on  the contralateral lung  were  12  %.  RESULTS.   Complications in  the  early  postoperative period  were  in  107  patients  (53.5 %),  postoperative lethality  was  12.0  %  (n=24).  Complications in  the  group  of  patients with  the  absence of  practically preserved lobe  were  in 84  patients (69.4  %)  while  the  complications in the  group  with practically  preserved lobe  were revealed only  in  23  patients (29.1  %)  (p=0.001). After  RB  in  the  groups where   bullas  adjoined to  almost   unchanged pulmonary tissue,  the  lethality  during  the  five-year  observation period  was  much  less,   than  in the  groups with clinically significant   pulmonary emphysema  in  the   remaining  after   operation  part   of  a  lung,  4.1  %  and   40.0   %  respectively (p=0.001). CONCLUSION.  After the  palliative  surgical  correction of RF  through  RB or LVRS, the  most  favorable survival criterion is the presence of parenchyma in the operated lung, which is practically not affected with emphysema.

The  OBJECTIVE  of the  study  is to assess the  possibilities of using  endoscopic techniques in the  treatment of diseases of  the  artificial  esophagus. MATERIAL AND METHODS.  Esophagoplasty for  benign   diseases of  the  esophagus  was performed in 184  patients. 73  patients were  diagnosed with diseases of the  artificial esophagus and  underwent various endoscopic  interventions. RESULTS.   Restoring patency of  the  anastomosis was  achieved in  all  cases of  esophageal anastomotic stenoses   (68).   No   complications  were   observed.   Endoscopic  interventions  in  other   diseases  of  the artificial  esophagus allowed   improving  the  quality  of  life,  restoring patency  or  preparing  the  patient   for  intervention. CONCLUSION.  Endoscopic methods of treatment of diseases of the artificial esophagus are highly effective, allowing to  restore patency of the  artificial esophagus and  esophageal anastomoses.  These interventions should  be  carried  out in the specialized departments.

The  OBJECTIVE  of the  study  is  to  evaluate the  approaches of surgical  treatment of complicated forms  of liver echinococcosis. MATERIAL AND METHODS.  During  the  period  from 2010  to  2016,  surgical  treatment of liver echinococcosis was  performed in 202  patients, 161  patients of them  (79.7  %)  had  primary  echinococcosis, and  41  patients (20.3  %) had  recurrent echinococcosis. The  work is based on the  retrospective analysis of the  results of preoperative examination, intraoperative  ultrasound  examination  and   treatment of  46  (22.8  %)  patients with  complicated echinococcosis  –  with isolated liver damage or  in combination with other  localizations. 8  patients had  concomitant  complications.  RESULTS. Cyst  suppuration is the  most  common among the  complicated forms  of liver echinococcosis. CONCLUSION.  Complicated liver echinococcosis should   be  operated in the  specialized institution  with modern diagnostic and  treatment equipment and  highly  qualified  specialists.

The  OBJECTIVE  is  to  study  the  effect  of application of different  pancreatic stump  closure techniques to  the  postoperative period,  the frequency and  severity  of postoperative complications including postoperative pancreatic fistulas  after distal pancreatectomies. MATERIAL AND METHODS.  The  clinical  material  consisted of 126  patients who  underwent distal  pancreatectomies  (isolated or  in  combination  with  surgical   interventions  on  the  adjacent organs of  the  abdominal cavity  and retroperitoneal space).  The  patients  were   divided  into  4  groups  depending  on  the  pancreatic  stump   closure  techniques (isolated suturing  of the  main  pancreatic duct  of the  pancreatic stump  with its omentization by gastrocolic omentum or local sealing its  by  hemostatic sponge  (control  group);  using  a  local  biological  glue  2-octylcyanoacrylate; using  the  Endoscopic Linear  Cutter  Echelon; external transduodenal  transnasal  drainage of the  enlarged main  pancreatic duct  of the  pancreatic stump). We  evaluated the  influence   of  different  pancreatic stump   closure techniques  after  distal  pancreatectomies on  the postoperative period  as well the  frequency and  severity  of postoperative pancreatic fistulas  depending on the  diameter of the main  pancreatic duct  of pancreatic stump.   RESULTS.  The  overall  rate  of postoperative  complications in the  control  group of patients was  45.8  %, and  was  due  to an  increase in the  frequency of specific  complications (35.4  %). The  most  frequent complication  in  the  control  group   of  patients  was   postoperative  pancreatic  fistulas   –  29.2   %.  The  statistically   significant decrease  of  frequency  and   severity   of  postoperative  complications,  frequency  and   severity   of  postoperative  pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were  revealed in comparison with the  control  group  of patients. There  was  no  hospital  mortality.  CONCLUSION. Distal  pancreatectomy with  «standard»  pancreatic stump   closure techniques  accompanied by  high  frequency and  severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after  distal  pancreatectomy led  to  a  decrease of  the  frequency and  severity   of  postoperative  complications, a decrease of the  frequency and  severity  of postoperative pancreatic fistulas,  and  a decrease of the  postoperative hospital-stay.

The  OBJECTIVE  of the  study  was  to clarify the  rational  program of diagnosis and  choice  of treatment tactics  for patients with neuroendocrine tumors  (NET) of the  small  intestine, taking  into account their clinical and  morphological characteristics. MATERIAL AND METHODS.  We  studied the  results of examination and  treatment of 39  patients. RESULTS.  CT is the main  method of topical  diagnosis, the  sensitivity  of which  in the  detection of NET of the  small  intestine is 96.4  %. Sign of  the  localization   of  NET  in  the  small  intestine is  the  tumor  conglomerate of  its  mesentery, which  includes diffuse-infiltrative  and   nodular   variant   of  changes.  The   diffuse-infiltrative  variant   of  tumor   conglomerate  is  characterized   by increased risk  of complicated course of tumor  process.  Cytoreductive surgical  treatment allows  to  increase the  survival rate   of  patients with  generalized NET  of  the  small  intestine in  1.7  times.   CONCLUSION.  Treatment of  patients with NET  of  the  small  intestine should   be  carried   out  in  specialized medical   centers that  have   the  ability  to  implement   a multidisciplinary  approach that  can  significantly  increase the  duration   and  quality  of  life of  patients.

The  OBJECTIVE  the  study  is to rate  the  clinical efficacy  of pelvic C-clamp  in patients with unstable pelvic ring injuries  and signs  of intrapelvical  ongoing  bleeding. MATERIAL AND METHODS.  We  studied the  results of treatment of 87  patients with unstable pelvic  ring injuries signs  of unstable hemodynamics. Pelvic  C-clamp  was  used for mechanical stabilization of the  posterior pelvic  half-ring  in order  to stop  the  ongoing  pelvic  bleeding. Surgical methods of hemostasis in addition to  the  stabilization of the  pelvis  were  used in 30  patients. Control  of systolic  blood  pressure in the  dynamics,  volume and   duration   of  blood   transfusion  therapy  were   carried   out  to  assess the   effectiveness  of  hemostasis.  Additionally, spiral computed tomography with intravenous contrast enhancement and pelvic diagnostic angiography were performed. RESULTS.   Surgical   methods of  hemostasis  combined with  mechanical  stabilization of  the  damaged pelvic  ring  made allow  to  achieve the  final  stopping of  the  ongoing   pelvic  bleeding in  ¾   patients. CONCLUSION. In severe concomitant pelvic  injury,  surgical   methods of  hemostasis in  combination with  mechanical  stabilization of  the  damaged pelvic  ring should   be  actively  used in  patients in  critical  condition.

Malformations  and  premature birth are  the  most  important  causes of chronic  diseases, disability and  mortality in childhood. Help  for  children   with  malformations  is  often  needed immediately   after  birth.  WHO  determines heart   defects,  neural tube   defects,  chromosomal  abnormality –  Down  syndrome as  the  most   severe  malformations. Down  syndrome  is  a genetic disease in which the child has the superfluous chromosome and often defects in the development of different organs and   systems. The  presence of  several defects  requires a  complex   surgical   approach that  can   be  performed endoscopically.  It  is  known  that  Down  syndrome  can   be  combined  with  chyloperitoneum.  The  article  represents  the clinical  observation  of  successful  treatment  of  the   newborn  baby   with  Down  syndrome,  which  was   combined  with congenital high  intestinal  obstruction at  the  level  of the  duodenum and  parasternal  diaphragmatic hernia, both  defects were corrected laparoscopically. The chyloperitoneum developed in postoperative period was successfully treated with the appointment of total parenteral nutrition and infusions of Sandostatin analogues.

The  OBJECTIVE  is to determine the  possibilities of using  tranexamic acid  for hip arthroplasty in patients receiving  renal replacement  therapy. MATERIAL AND METHODS.  The  material   for  the  study   was   based on  the  data   of  31  patients with pathology of the  hip who  underwent primary  total  hip arthroplasty from 2015  to 2017  at  the  Clinic of Traumatology and   Orthopedics  of  the  «Pavlov   First  Saint   Petersburg State  Medical  University».   RESULTS.   The  study   proves the safety   of  using   tranexamic  acid   for  total  hip  arthroplasty  in  chronic   hemodialysis patients.  CONCLUSION.   The   use of tranexamic acid  for hip arthroplasty in patients receiving  renal  replacement therapy allows  to  reduce blood  loss.  The efficacy  was  33  %  (p<0.05).   It is  necessary to  strictly  adhere to  the  frequency of introduction  of tranexamic acid,  and dose  adjustment depending on  the  concentration of  blood  creatinine.

The OBJECTIVE is to evaluate the results of introduction of the new method of preparation in patients with deep neck  burns to the imposition of tracheostomy. MATERIAL AND METHODS. The study included 124 patients with extensive  deep burns and inhalation injury. The method of treatment consisted of early (3–4 days from the moment of injury)  necrectomy with simultaneous autodermoplasty in the projection of the anterior surface of the neck and torso on the area  of 1–1.5% of the body surface. Tracheostomy was performed after graft engraftment. RESULTS. According to the proposed  method, 20 patients were operated. 17 of them were subjected tracheostomy through the restored skin on 11.6±1.8 days.  CONCLUSION. The method of the early recovery of th skin in the projection of tracheostomy in patients with deep burns  of the neck allows to safely subject tracheostomy through the restored skin on 8–14 days from the moment of the burn.

The  OBJECTIVE  of the  study  is  to  improve  in the  surgical  condition  of endoscopic longitudinal  gastroplasty in patients with morbid  obesity.   MATERIAL AND METHODS.  The  prospective randomized controlled   research of 68  patients  who underwent endoscopic sleeve gastroplasty. The 1st  group  (n=23)  –  neuromuscular  blockade (NMB) was  performed  by bolus  injection  of rocuronium, the  patients on  the  operating table  were  in a  flat position.  The  2nd  group  (n=23)  –  NMB was   maintained  by  intravenous  infusion   of  rocuronium, patients  on  the   operating  table   were   in  the   Trendelenburg position.  The  3rd  group  (n=22)  –  basic  anesthesia in combination with prolonged epidural  analgesia (PEA),  NMB were maintained at  a  deep level  by  intravenous infusion  of rocuronium, patients  on  the  operating table  were  in the  «beach chair»   position.   Neuromuscular  monitoring,   monitoring   of  central   and   peripheral hemodynamics  were   performed. The elasticity  of the  anterior  abdominal wall (E), intra-abdominal pressure (IAP), intra-abdominal volume  (IAV) were  calculated. RESULTS.   During  the  analysis of  the  dynamics of  the  average level  of  intra-abdominal volume  and  pressure, it was found  that  the  mean IAV level  in the  3rd  group was significantly higher at all stages of the study than in the 1st  and the 2nd  groups, and  the  IAP level  was  significantly  lower  in the  3rd  group at all stages of the study than in the 1st  and the 2nd  groups. CONCLUSION.  The  maintaining of  muscle  relaxation at  a  deep level  under   the  regime   of  continuous infusion,  the  inclusion  of ropivacaine in the  anesthetic  regimen of PEA,  the  use   of the  «beach chair»  position  for the patient   on  the  operating table  contribute to  the  improvement of  surgical   condition  during  the  endoscopic  gastrectomy in  patients with  morbid  obesity.

The  OBJECTIVE  is to improve  the  results of surgical  treatment of patients with large  and  giant  EHH. MATERIAL AND METHODS.  We  present our  experience of surgical  treatment of 25  patients with large  and  giant  EHH, who  underwent laparoscopic  interventions according to  the  original  technique, which  consisted in the  method of plasty  of esophageal hiatus:   the   mesh  implant   was   installed   and   fixed  in  the   posterior  mediastinum  above  the   diaphragm.  RESULTS. Intraoperative  bleeding  was   noted   in  2  (8  %)  patients,  which  did  not  require   conversion.  In  the  near   postoperative period,   no  complications  were  noted.   In  the  long-term   periods from  1  to  5  years, there   was  no  recurrence of  EHH and  complications associated  with the  use   of mesh implant.  CONCLUSION.  Videoendosurgical  interventions  are  the operations  of  choice  in  the  treatment  of  patients  with  large  and  giant  EHH.  The  most  effective  method  of  plasty for  large  and  giant  EHH  is  the  combined plasty  of  the  esophageal hiatus   by  a  mesh implant  in  combination  with  a posterior  cruroraphy,  with  the  installation   and   fixation  of  the  mesh implant  in  the  posterior mediastinum above  the cruses of diaphragm.

The  OBJECTIVE   is  to  assess the  patency  of  the  inferior  mesenteric artery   and   internal   iliac  arteries in  the  remote period  after  resection of the  aneurysm of the  infrarenal  aortic  segment. MATERIAL AND METHODS.  The  study  included 33  patients who  underwent resection  of  the  abdominal aortic  aneurysm with  reconstruction of  the  inferior  mesenteric artery  and  (or)  internal  iliac  arteries from  1998  to  2017.   All patients were  examined with  computed  tomography scan with  contrast to  assess the  patency of  inferior  mesenteric artery  and   internal  iliac  arteries. RESULTS.   Patients  were observed from  0.5  to  15  years. Among  30  patients with  inferior  mesenteric artery   implanted  into  the  prosthesis,  23 (76  %)  patients had  a  passable inferior  mesenteric artery  and  7  patients had  an  occluded inferior  mesenteric artery. The  implanted  inferior  mesenteric artery   maintained its  patency for  3  years in  100%   of  cases, from  3  to  5  years  – in  86%,  after  5  years and   more   –  in  62%.  In  one   patient   who  underwent  reconstruction  of  the  internal   iliac  artery, thrombosis  of  the  prosthetic-internal  iliac  shunt   was   found  out  in  1.5  years  after  the  operation,  without  any  clinical manifestations. One  patient,  underwent the  reconstruction of the  internal  iliac artery,  was  diagnosed with thrombosis of the prosthetic-internal iliac  shunt   in  1.5  years after  the  operation, which  was   not  accompanied by  clinical  manifestations. CONCLUSION.  The  high  remote patency of the  inferior mesenteric artery  and  internal  iliac arteries reconstructed during resection of the aneurysm of the infrarenal aortic segment indicates the need for this procedure in order to prevent ischemic disorders of the digestive organs and pelvis.

The paper presents the clinical case that reflects the difficulties of diagnosis and choice of treatment tactics of patients with neuroendocrine tumors   of the  small  intestine. The  sequence of instrumental diagnostic methods  made  it possible to determine the localization of the tumor in small intestine and to clarify the prevalence of the tumor process. The implementation of active surgical treatment tactics allowed performing cytoreductive surgical intervention, eliminating the risk of complications of the  tumor  process and  improving  the  quality of life of the  patient  with generalized neuroendocrine tumor of the small intestine.

Almost  every  operation on  the  abdomen ends with drainage.   However,   according to  the  data   of foreign  publications, surgeons all over  the  world refuse this  technique increasingly. Based  on  the  data  of domestic and  foreign  publications, the  indications and  the  need for  abdominal drainage  in  various   types   of  surgical   interventions were  analyzed.

The  paper highlights  the  main  issues of  prevalence, pathogenesis  and  diagnosis of  gastroesophageal reflux  disease. The  principles   and  key  problems of  surgical   treatment of  this  pathology are  highlighted.