The  article  is  dedicated to  the  memory   of  the  Russian  surgeon,  prominent scientist, public  health   organizer and   the founder  of the  first Russian periodical  surgical  journal  of N. A. Vel’jaminov  in 1885,  who  was  born  165  years ago  and died  100  years ago.

INTRODUCTION.  Coronary  artery   bypass  surgery is  the  most   popular   method  of  surgical   treatment of  patients with chronic   heart   failure  of  ischemic  origin.  Modern   direction   of  developing  the  cardiac  surgery  in  treating   patients  with chronic  heart   failure  of  ischemic origin  is  «off-pump»   techniques. However,   the  high  risk  of  emergency  conversion  to

«on  pump»   reduce the  availability  for using  «off pump»   techniques with this  kind  of patients. Preoperative risk  factors for  unplanned conversion to  cardiopulmonary bypass  have   not  been studied.

The  OBJECTIVE  was  to  determine preoperative risk factors  of urgent  conversion to  bypass in patients with congestive ischemic heart   failure  during  off-pump  coronary artery  bypass  grafting.

METHODS  AND MATERIALS. The  results of 44 coronary artery  bypass grafting  (CABG) off-pump  procedures in patients with  ischemic  cardiomyopathy were  retrospectively analyzed.  Emergent  conversion to  artificial  circulation  was   needed due   to  acute heart   failure  in  8  (18  %)  patients. All patients were   divided  into  2  groups depending on  the  necessity for  emergency using  the  cardiopulmonary bypass.  Then  the  patients’   preoperative status was  analyzed.

RESULTS.   We  determined  that   the   risk  factors   of  emergent  conversion  to  cardiopulmonary bypass  were   observed in the  following cases:  patients after  70  years old  with a  combined left main  coronary artery  lesion  and  right  coronary artery  occlusion; left  ventricle  end-diastolic size  more  than  70  mm;  mild  mitral  insufficiency;  the  presence of  atrial  or ventricle  rhythm  disturbances;  EuroSCORE logistic  score more  than  4.9  %.

CONCLUSION.  The  identified  risk  factors   allow  to  minimize  the  risk  of  urgent   conversion to  bypass circulation  during off-pump  myocardial revascularization  in  patients with  congestive  ischemic heart   failure.  When   these risk  factors   are present, it is  recommended to  use   on-pump or  on-pump beating  heart   techniques of  coronary artery  bypass  grafting in  these  patients.

The  OBJECTIVE   was   to  assess the  effectiveness  of  the  developed  method  for  treating   DVT  with  fibrinolytic agent injection  via  a  catheter with  multiple  openings along  the  length  of  entire  thrombus.

METHODS  AND MATERIALS. The  analysis of treatment efficacy  of 40  patients with late  total  and  subtotal deep  vein thrombosis was  carried  out.  The  patients were  divided  into two statistically  valid groups. The  first group  of patients weretreated using  regional   thrombolysis by  injection  of  Urokinase into  the  popliteal  vein.  The  second group  had  fibrinolytic agent injection  via  a  catheter with  multiple  openings passed  along   the  entire   length   of  thrombosed venous segment. Patients were  given  Rivaroxaban before, during,  and  after  the  therapy  continuously for  6  months.

RESULTS.   After 1  year  in the  second group,  compared to  the  first group,  the  excellent and  good  results were  higher by  10  %  and  5  %  respectively. Satisfactory and  unsatisfactory results decreased  by  10  and  5  %  respectively.  While using  background Rivaroxaban, the  thromboembolic complications were  not  registered. Hemorrhagic complications were found  in  10  %  of  both  group  patients with  equal   rate.

CONCLUSION.  Injection  of a  fibrinolytic agent via a  catheter with multiple  openings along  the  length  of entire  thrombus is  efficient  and  pathogenetically substantiated.

The OBJECTIVE was to study the impact of various hernioplasty methods on the reproductive system.

METHODS AND MATERIALS. The study was performed in two groups of patients. Depending on the herniatomy technique, the patients were divided into two groups. Desarda hernia repair was performed in the first group, and Shouldice hernioplasty - in the second group. The study included 68 patients with inguinal hernia. 38 patients from the first group underwent operative interventions, and 30 patients from the second group underwent Shouldice hernioplasty. Both analyzed groups were identical. Prior to operative treatment and in 20 days, 6 months and a year after operation, color duplex scanning of arteries and veins of the spermatic cord was performed on an ALOKA SSD ultrasonic scanner - 1700 with a linear sensor of 7.5 MHz. A sperm morphology was studied 6 days before the operation, 3 months later and one year after the operation according to the Kruger - Menkveld criteria.

RESULTS. Laboratory tests of ejaculate are an integral part of examination of patients, necessary for diagnostics of genital glands functional disorders and the statement on the fertility of the patients. The test showed that the concentration, sperm motility and testosterone level were better with Desarda surgery than with Shouldice. Ultrasonic sonoelastography was performed in 58 patients (85.3 % of patients in both groups). Decreased tissue elasticity and increased testicular tissue density were observed in 25 (36.8 %) patients before surgery. Positive changes in the testicular blood flow velocity were noted in the patients with indirect inguinal hernias surgically operated by the Desarda technique. In patients surgically operated by the Shouldice technique, the resistance index significantly increased, which is typical for spermatic cord compression (p<0.005). 6 months after operation, the blood flow normalized in 97.4 % of patients surgically operated by Desarda technique, and in 66.6 % of patients surgically operated by Shouldice method. CONCLUSION. Based on the data analysis, Desarda hernioplasty has a minimal impact on the epidemiologic testicular function and preferably for patients of reproductive age in order to maintain reproductive function.

The OBJECTIVE of this research was to compare the accuracy and the possibility of applying the most common scales for acute pancreatitis severity evaluation with each other as well as with the suggested scale developed specially for this disease and based on the illness severity coefficient, which is defined by objective quantitative parameters available for every practitioner.

METHODS AND METERIALS. We examined the data on 16 parameters for 760 patients suffering from acute pancreatitis, who were treated at the following 3 hospitals.

RESULTS. One of the drawbacks of all the examined scales is low sensitivity of scales with high specificity. This feature makes these scales inadequate for making decisions about the therapeutic approach for a patient.

CONCLUSION. The suggested way of defining the illness severity is entirely free of subjectivity, does not depend on surgeon's qualification and has high specificity to a concrete problem. It is worth noting that all scales except IDAP use the indicators that are not included in medical-economic standards of Russia. Therefore, the IDAP scale is best suited to address our problem.

INTRODUCTION. The results of the treatment of patients with restrictive burns I-II degrees are presented in the article. The OBJECTIVE of the research was to establish the efficiency of the usage of polyhexanide included in wet environment in the treatment of burns I-II degrees.

METHODS AND MATERIALS. The research was conducted in 2 groups of patients. In the first group (N=33), local treatment of hand wounds was performed in condition of wet environment created by isotonic solution of sodium chloride, in the second group (N=18) - with usage of polyhexanide as antiseptic and isotonic chloride saline solution. For evaluation of efficiency of the treatment, we studied the terms of the beginning of epithelialization of the wound surface, pain syndrome severity, microcirculation and conducted microbiological research of wound exudate.

RESULTS. The appearance of the first signs of wound epithelialization after the beginnings of treatment was observed in 1.5 times in average sooner in the second group than in the first group. Pain syndrome was jugulated by the 3rd day in the first (research) group in 19 % of cases, in the second (control) group - in 46 % (p<0.05). In the second group, perfusion of tissues in the border area reduced, in the same time in the first group, it remained unchanged. The number of swabbing cases with Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae and Enterococcus faecalis increased in the first group by the 3rd day in contrast with the second group, where such cases was not noted or occurred significantly less often.

CONCLUSION. The usage of polyhexanide as a part of wet environment promotes the reduction of wound surface swabbing level that allows to speed up the appearance of the first signs of wound epithelialization, reduces the severity of pain syndrome, and modeling of tissue microcirculation in periwound area.

The OBJECTIVE was to evaluate the technical feasibility of endoscopic hernioplasty in recurrent inguinal hernia. METHODS AND MATERIALS. Personal experience of the authors covers more than 10 000 laparoscopic inguinal hernioplasties operated in 1996-2018. This paper analyzes the results of 127 patients treated for recurrent inguinal hernias after primary laparoscopic approach, reoperated using minimally-invasive surgical techniques.

RESULTS. Possible causes of relapses after primary hernioplasty, both after TAPP and TEP techniques, were analyzed. The technical features of performing repeated laparoscopic interventions in this group of patients were considered. The developed and implemented technical methods, the tactics of the surgical treatment, the choice of the prostheses' type and size used in patients with various kinds of recurrent inguinal hernias were described. Results of the study included an analysis of the treatment while recommendations on the technique of repeated surgical intervention of recurrent hernias were formulated. The safety and effectiveness of the laparoscopic repeated surgery for recurrent inguinal hernias were shown. CONCLUSION. Laparoscopic approach to hernioplasty in recurrent inguinal hernia is equally effective after open and endoscopic primary repair. An increase in the number of hernioplasty for recurrent inguinal hernias with non-adhesive mesh grafts is promising. Contraindications to redo laparoscopic intervention may include high risk of general anesthesia and severe scarring in the lower abdomen.

INTRODUCTION. The issues of prevention of postoperative gastroesophageal reflux in patients undergone laparoscopic sleeve gastrectomy (LSG) is the most relevant, due to the increase in the number of these surgical interventions and patients who note manifestations of gastroesophageal reflux disease (GERD) in the long-term period after surgery.

The OBJECTIVES was to evaluate the effectiveness of the antireflux mechanism of our proposed modified method of laparoscopic longitudinal gastrectomy with the formation of a three-chamber gastric «sleeve».

METHODS AND MATERIALS. The study was based on the data from clinical examination of patients with morbid obesity, who were operated on in the NHI «Railway Clinical Hospital» at the Rostov-Glavnyi station in 2008-2019. We made comparisons of the clinical manifestations of GERD before and after surgery in patients who underwent LSG using classic and modified technique.

RESULTS. As a result of the study, we were able to identify that a year after both types of operations, patients showed an increase in GERD symptoms. And in 47 % of all operated, GERD appeared de novo. However, we managed to fix the difference between the frequency of occurrence of reflux in the studied groups. Thus, a year after the operation, in the control group, the clinical manifestations of reflux increased by 25 %, both in qualitative and quantitative indicators. While in the study group, these manifestations were increased by 13.5 %.

CONCLUSION. The use of the antireflux surgery of prostate cancer proposed by us in patients with morbid obesity significantly improves their quality of life with symptoms of GERD and can be used in patients with existing GERD symptoms before surgery and without them.

The paper presents a clinical case that reflects difficulties of primary hyperparathyroidism diagnosis, as well as an experience of usage of new methods in parathyroid surgery, which aims at increasing degree of evidence and safety of interventions. The sequence of the implemented methods of laboratory and instrumental examination made it possible to identify the accurate location of parathyroid adenomas, and realization of the proposed surgical tactics - to perform a surgical intervention justified in terms of volume and methodology, to avoid postoperative complications and improve the patient's quality of life.

The article presents a rare variant of recurrent retrosternal goiter located in the posterior mediastinum. The localization and size of the goiter required the supplementation of traditional cervical access with a partial longitudinal sternotomy. It was shown relationship between the development of recurrent retrosternal goiter and nonradically performed primary operation. 

A rare clinical case of material pulmonary embolism is described. After 2 month of reconstructive surgery on the spine, on the chest cavity organs X-ray picture spiral solid was revealed. Surgical intervention - removal of a foreign body of the pulmonary artery with a good result.

Bland - White - Garland syndrome (BWGS) is a clinical symptom complex, which is based on the congenital anomalous discharge of the left coronary artery of the heart from the pulmonary trunk. This article presents a case report of successful surgical treatment of BWGS in an adult patient (25 years). The patient after childbirth began to note fatigue, angina pectoris, dyspnea, heartbeat with rapid walking up to 100 meters. The patient underwent coronary angiography, echocardiography, multispiral computed tomography. As a result of researches, it was established abnormal discharge of the left coronary artery from the pulmonary trunk. Surgical treatment was performed - reimplantation of the main left coronary artery into the aorta with repair of the pulmonary trunk with xenopericardium. Discharged on the 16th day after surgery.

Transposition of internal organs (situs inversus viscerum) is a rare version of biologically normal anatomy, in which the main internal organs have a mirror (reverse) arrangement compared to the normal position. Diseases of epiploic appendage (torsion, inflammation, necrosis) are rare and make up 0.1-0.3 % of acute diseases of the abdominal organs. A clinical case of treating a patient with acute appendicitis in combination with torsion and necrosis of epiploic appendage in the transposition of internal organs is presented.

The practice observation is given - surgical treatment of the patient with the cyst of the common bile duct. 34 years old patient was received with complaints of recurrent paroxysmal pain in the upper abdomen, nausea, vomiting, chills and fever up to 39 ^оС. During the process of examination, the cyst of the common bile duct was detected. The following procedures were performed for the patient: laparotomy, cyst of the common bile duct resection, Roux-en-Y bilio - jejuna anastomosis, Felker drainage.

The problem of bowel viability assessment during surgery is still opened. High value predictive and economically available technique is thought to decrease postoperative morbidity and mortality during elective and urgent abdominal surgery. To evaluate the available techniques for intraoperative bowel viability assessment, the search of Russian and foreign up-to-date literature was performed. Parameters of techniques are analyzed: intraoperative clinical application, invasiveness, objectivity and quantification of viability parameters, predictive value for necrosis and anastomotic leakage. There is still no standardised and available for every operative theatre method for bowel viability assessment during surgery. Numerous of techniques such as near-infrared fluorescence (NIR) angiography, using indocyanine green (ICG), optical coherence tomography (OCT), laser doppler flowmetry (LDF) are proposed to be more evaluated and perspective. Autofluorescence spectroscopy for NADH and flavoproteins seems to be a promising tool for early detection of nonviable bowel segments.

The multifactorial nature of the problem of venous thromboembolic complications (VTEC) in oncological surgery underlies that, despite the widespread introduction of risk criteria and routine thromboprophylaxis in practice, it is not possible to completely prevent these postoperative complications. Ensuring the highest level of patient safety for VTEC is one of the priority tasks of the surgical service specialists. Surgical practice requires the development of reasonable criteria for prolonged medical prophylaxis of VTEC and the introduction of methods for the early detection of latent venous thrombosis.

Bariatric (metabolic) surgery is currently considered as the most effective treatment for obesity with its comorbidities and metabolic disorders like Diabetes Mellitus type 2. Due to life-long nature of obesity, high rate of its recidivism and increasing number of bariatric/ metabolic operations performing worldwide, the problem of revisional bariatric surgery is becoming extremely actual. The article based on literature data and author's own experience overlooks possible solutions for choice of revisional operations depending on kind of primary bariatric procedure, causes of revision: weight regain, complications and side effects of the primary operation.

The article is devoted to the development and implementation of the method of hemotransfusion of cadaveric blood to living people, thanks to which methods of blood preservation, fibrinolysis received its development. Currently, this method of hemotransfusion therapy may be in demand in the use of components of donor blood, including, from a conditioned donor, in organ transplantation to single-group recipients. Understanding the process of fibrinolysis is key to preventing and stopping bleeding in certain surgical pathologies.

The article is dedicated to the 115th anniversary of the birth of L. K. Bogush. Lev Konstantinovich was born on March 3, 1905 in the family of the famous Nizhny Novgorod surgeon Konstantin Fedorovich Bogush. The industriousness, high capacity for work, dedication to science and the talent of Lev Konstantinovich for a short time bore fruit. In 1939, Lev Konstantinovich was one of the first in the country to remove a lung lobe due to suppurating bronchiectasis. In 1943, Lev Konstantinovich defended his doctoral dissertation «Surgical treatment of pulmonary tuberculosis by ligation of pulmonary lobar veins». In 1961, L. K. Bogush, together with professors B. V. Petrovsky, N. M. Amosov, F. G. Uglov and V. I. Struchkov, was awarded the Lenin Prize for the development of lung operations. On October 5, 1994, after a long-term illness, Lev Konstantinovich died and was buried at the Kuntsevsky cemetery in Moscow.