Professor Lev Vasilievich Potashov was born on May 21, 1930, and graduated from the 1st LMI in 1954. In 1964, he was the first in the country to perform a coronarography. He studied problems of gastrointestinal bleedings, lymphology, ultraviolet blood irradiation, ischemic diseases of the digestive system. Until the last year of 2020, he worked at the University.

The objective was to determine the effectiveness of biliary drainage/stenting before admission to the specialized Department of hepatobiliary surgery in patients with Klatskin tumors and the possibility of subsequent specific treatment.

Methods and materials. During 2015-2019, 58 patients with Klatskin tumor (Bismuth - Corlette types: I - in 4 pts; II - 6; III - 36; IV - 12) were hospitalized with biliary drainage/stenting performed in outside hospitals because of obstructive jaundice. In 45 (78 %) patients due to uncontrolled cholangitis and /or obstructive jaundice, correction and/or additional drainage of the bile ducts was required: resetting from external to external-internal (n=23), additional drainage of the left lobe and Siv (n=16), removal of endoscopic stents and new percutaneous drainage (n=6). 48 patients received combination of intraductal photodynamic and regional chemotherapy. After 2-8 (average 3) cycles of specific therapy, 14 (24 %) patients underwent surgery: right hemigepatectomy - 4; left expanded hemigepatectomy - 4; left hemigepatectomy - 3; duct resection with Siv - 2; orthotopic liver transplantation - 1.

Results. From the first appearance of obstructive jaundice to the beginning of specific treatment, it took 1 to 9 (average 3.1) months. The technical success of repeated endobiliary interventions was 100 %. There were no serious complications or mortality. Both the cholangitis and obstructive jaundice were controlled in 35 (78 %) patients. 14 out of 48 (30 %) patients showed a metabolic and biological response of the tumor to combined treatment (PET/CT with F 18FDG and CA-19.9) and underwent radical surgery. Specific therapy was not performed in 10 (17 %) patients with long-term jaundice and the development of biliary cirrhosis (n=6) and chronic cholangitis (n=4).

Conclusion. Before the admission to the specialized Department, previously installed bile duct drains/stents were effective in 22 % of patients. Only adequate biliary drainage with regular x-ray monitoring allows to start aggressive specific therapy in 83 % of patients with Klatskin tumor. The advantage of photodynamic and regional chemotherapy after percutaneous biliary drainage is their repeatability with local control of tumor and the possibility of subsequent radical surgical treatment, including orthoptic liver transplantation.

Treatment of complications of peptic ulcer disease is an urgent problem in abdominal surgery due to the high prevalence of bleeding (19-57) and perforations (3-14 cases per 100,000 population).

The objective of the study was to assess the possibility of predicting the development of ulcerative disease complications determining the ratio of the level of melatonin receptors (MT1/MT2) in the duodenal mucosa.

Methods and materials. 56 patients with different course of peptic ulcer disease were examined. All patients underwent esophagogastroduodenoscopy with biopsy of the bulb duodenum. Biopsies were analyzed on a flow cytometer. The results were statistically processed.

Results. The ratio of melatonin receptors MT1/MT2 significantly differed in the group of patients with bleeding and in the group with perforation. During the statistical analysis, it was found that at a value of MT1/MT2≥1,7, it is possible to assume the development of complications in the patient in the form of perforation or bleeding.

Conclusion. The method of determining the ratio of melatonin receptors (MT1/MT2) in patients with complicated peptic ulcer disease can be used for prediction the risk of complications.

The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.

Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.

Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.

Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.

Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.

Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.

Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.

Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.

The objective of the study was to compare the results of two methods of thermo-obliteration of the fistula track by diode laser or monopolar electrocoagulation in patients with trans- and suprasphincteric anal fistulas.

Methods and materials. 52 patients (men - 40, women - 12) were included in the study. 29 patients underwent laser coagulation (Laser group) and 23 patients underwent monopolar electrocoagulation (ME group) of fistula track combined with closure of internal fistula opening. Mean age of patients in Laser group was (46±13) years, in ME group - (41±12) years. In the Laser group, 11 (38 %) patients had suprasphincteric fistulae, and 18 (62 %) had transsphincteric fistulae passing through a superficial or deep portion of the external anal sphincter. In the ME group, 9 (39.1 %) patients had an suprasphincteric fistula and 14 (60.9 %) had a transsphincteric fistulae. The minimal period for assessing the healing rate was 2 months after surgery.

Results. The average follow-up period after Laser was (9.5±3.0) (5-18) months, after ME - (12.2±7.3) (2-22) months. Primary healing of fistula in 2 months after surgery was 19/29 (65.5 %; 10 transsphincteric and 9 suprasphincteric fistulas) in the Laser group versus 7/23 (30.4 %; 5 transsphincteric and 1 suprasphincteric fistulas) in the ME group (p<0.05). There were no cases of fecal incontinence development after laser or monopolar coagulation of fistula track.

Introduction. Heel bone fractures account for about 3 % of the total number of fractures. Various methods of surgical treatment were used depending on the features of a fracture, the condition of soft tissues in a damage area, the general condition of a patient and co-morbidity.

The objective was to improve the results of treatment of heel bone fracture by using screws made of glycosylated lactic acid.

Methods and materials. The examination and treatment methods as well as the results of surgical treatment of 89 patients diagnosed with a heel bone fracture were analysed. Depending on the type of fractures, all the patients were divided into 4 groups according to Sanders.

Results. We studied the short-term (100 %) and long-term (82.5 %) results of treatment of patients using the point-based assessment systems - the Foot Function Index (FFI) scale, and the Clinical rating system for the Ankle and Hindfoot scale.

Conclusion. The current study showed that the use of bioimplants along with classical osteosynthesis is one of the advanced technologies in traumatology and orthopedics, which allows to expand the possibilities of surgical fixation of heel bone fractures.

introduction. Coronary bypass surgery is an integral part of the modern treatment of coronary heart disease. The desire to minimize operational complications of the classic method of coronary bypass surgery contributed to the development of minimally invasive techniques - the performing off pump myocardial revascularization from the left-sided anterior-lateral thoracotomy (minimally invasive coronary bypass surgery).

The objective was to present the optimal preoperative protocol for further examination of patients who are scheduled for multi-vessel minimally invasive coronary bypass surgery.

Methods and materials. In the cardiac surgery Department of the Saint Petersburg state budgetary institution «City Hospital No. 40 of the Kurortny district» in the period from July 2014 to December 2019, a total of 290 operations of multi-vascular minimally invasive coronary bypass were performed.

Results. Based on the analysis of the performed surgical interventions, the preoperative examination protocol and the optimal technique for performing the intervention are presented.

Conclusion. The safety and effectiveness of multi-vessel minimally invasive coronary bypass surgery, like any other minimally traumatic operation, depends on the selection of patients. Performing the preoperative examination protocol allows you to develop an individual approach to the surgical treatment of each patient.

The objective was to study the possibilities of using the C-arm based universal angiographic complex as a navigation system in transthoracic biopsies of pulmonary nodules.

Methods and materials. The study is based on the data of 60 patients with lesion size from 10 to 103 mm (mean 51 mm) have been underwent the transthoracic biopsy using C-arm based universal angiographic complex navigation. A total of 69 biopsies were performed (60 primary, 9 repeated). The procedure was made with local anesthesia in an interventional operating room. The postoperative observation time was 1 day.

Results. A tissue sample was got in all cases. As a result of a biopsy, a malignant tumor was confirmed in 70 % of patients (42 people). At the primary biopsy, data for the malignant process were not obtained in 30 % (18 people), however, in half of the cases (9 people), the diagnosis of a malignant tumor was confirmed after repeated biopsy. The radiation dose received by the patient was 2.05-60.50 mSv (mean 13.94mSv), which is comparable to the radiation dose in traditional CT navigation and less than the average dose of radiation obtained using CT fluoroscopy. Sensitivity, specificity, accuracy were 82.35, 100 и 35 % respectively. Complications occurred in 18 cases (26.09 %). There was no need to perform interventions under general anesthesia. Transfer of patients to the intensive care unit was not required. No fatal complications occurred.

Conclusion. This navigation system is safe and effective and can be used routinely.

Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied.

The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection.

Methods and materials. A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection.

Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p<0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p<0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01).

Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.

Reimplantation of a bicuspid aortic valve is relatively rare, and in combination with a the correction of aortic ductus diverticulum is a casuistic case. We present the experience of simultaneous reimplantation of bicuspid aortic valve with the correction of aortic ductus diverticulum. A 53-year-old male with a diagnosis of ascending aortic aneurysm, bicuspid aortic valve type 0 by Sievers with failure, aortic ductus diverticulum. The patient underwent an aortic valve reimplantation operation using the vascular prosthesis UniGraft № 36 and exoprosthetics of the descending aorta in the area of diverticulum. In the postoperative period, satisfactory aortic valve function was observed on ultrasound of the heart. The patient was discharged on the 15th day.

The study was to report a case of surgical treatment of multinodular cervicothoracic goiter complicated by compression syndrome of the neck (compression of the trachea, esophagus) with severe comorbid pathology.

The diagnosis and treatment of multiple endocrine neoplasia type 2A syndrome or Sipple’s syndrome, as well as other endocrine hereditary syndromes, presents certain difficulties for several reasons. One of them is the rarity of this pathology and, as a result, the lack of awareness of physicians. In addition, the diagnosis requires a comprehensive examination and a high level of clinical, laboratory, radiation and morphological diagnostics. And finally, surgical treatment, which is essentially the only method, involves an individual approach to each patient. We present the clinical case of Sipple's syndrome in a 39-year-old man. The diagnosis was carried out of medical history, clinical examination, laboratory tests (24-hour urine excretion of metanephrines and normetanephrines; serum calcium, calcitonin and parathyroid hormone levels), neck ultrasound and abdominal CT scan and was confirmed by histopathological examination and genetic testing for RET mutation. The achievement of the endpoint in the form of normalization of blood pressure and the absence of adrenal insufficiency was due to radical surgical treatment.

The clinic, diagnosis and treatment of two cases of dolichocolon torsions are represented: a women 31 and a men 34 years old. The represented clinical observations show diagnostic difficulties encountered in patients with congenital malformations of the colon.

Congenital short bowel syndrome is a rare condition of the newborn, with several reports demonstrating high mortality. For the first time in Russia, we report a case of treatment of a newborn girl with genetically confirmed congenital short bowel syndrome, and also provide a review of the literature on this syndrome. After birth, the child experienced constant vomiting of bile with a progressive decrease in body weight. The laparotomy for congenital adhesions between the loops of the small intestine with severe violations of the evacuation function revealed that the small bowel was 50 cm in length, confirming the diagnosis of congenital short bowel syndrome. The genetic test, using whole exome sequencing, identified a homozygous mutation in the CLMP gene in this patient. A positive result in the postoperative period was achieved using the protocol for the management of patients with short bowel syndrome. Currently, the girl is 11 months old, body weight is 9 kg, development is harmonious. Long-term survival of children with congenital short bowel syndrome is now possible if enteral feeds are introduced early to promote intestinal adaptation, with subsequent weaning off parenteral nutrition.

Small intestine hemangioma is a benign vascular tumor formation, accounts for 0.05 to 0.3 % of all gastrointestinal tumors. This article presents a rare clinical observation - intraluminal hemangioma of distal parts of the ileum in a boy of 7 years old, complicated by massive bleeding. The presented clinical observation shows the difficulty of diagnosis, as well as the preliminary diagnosis performed by a pediatric surgeon: Meckel’s diverticulum, complicated by bleeding. As we know, more than 70 % of cases of gastrointestinal bleeding in children are really associated with the pathology of Meckel’s diverticulum. This requires the transfer of such patients to a surgical hospital, performing surgical intervention for revision of the abdominal cavity and excision of the pathological formation, as well as additional surgical techniques depending on intraoperative tactics.The described case demonstrates effective diagnostic tactics and features of intraoperative picture, surgical treatment of patient based on laparotomy and resection of intestinal area. The possibility of achieving encouraging results of surgical treatment of this difficult category of patients with reasonable choice of surgical tactics in childhood has been demonstrated. It is obvious that the key to successful treatment of such patients is timely diagnosis, which is not easy task due to the morphological and topographic characteristics of the pathological focus.

The paper presents the latest data on applications of various types of endovascular interventions on the superior mesenteric artery. Efficiency of a number of devices for reperfusion therapy with acute mesenteric ischemia is described.

The results of works with the largest samples of patients (frequency of laparotomy, intestinal resection and lethality), timing of endovascular surgery and comparative results of open and endovascular operations in the basin of the superior mesenteric artery are also discussed.

The review presents the characteristics of modern biocompatible and biodegradable wound dressings on the basis of seaweed polysaccharides (carrageenans of red algae, fucoidans and alginates of brown algae, ulvans of green algae) and notes the key physicochemical and biological properties that are important for constructing wounds dressings. There are information on various types of wound dressings and results of experimental and clinical tests of dressings in the treatment of wounds of various origins. Particular attention is paid to hydrogel dressings, since hydrogels meet the basic requirements for an ideal wound dressing, and many marine polysaccharides are able to form hydrogels.

Professor Pavel Nikolaevich Napalkov was born in Moscow on September 30 (October 13), 1900. After graduating from secondary education, Pavel Nikolaevich entered the medical faculty of Don University, where he chose surgery as his future specialty. In 1930, by the invitation of Professor V. A. Oppel, P. N. Napalkov moved to Leningrad, where he began working in the hospital named after I. I. Mechnikov (now Peter the Great). During World War II, Pavel Nikolaevich was in the ranks of the Red Army. P. N. Napalkov summarized the experience of his work in the chapters «Putrid Infection» and «Peritonitis» in the fundamental multi-volume publication «Experience of Soviet Medicine in the Great Patriotic War of 1941-1945». After demobilization, Professor P. N. Napalkov was elected head of the Department of Faculty Surgery of the 2nd Leningrad Medical Institute and headed the department for 28 years - until 1974. Many works, including a dissertation and a monograph, were devoted to ventral hernias. Pavel Nikolaevich was the author and co-author of more than 400 scientific papers and 14 monographs on various sections of specialty surgery, military surgery, traumatology, anesthesiology, and health care organization. Professor P. N. Napalkov died on May 18, 1988 and was buried near Leningrad in the settlement Pesochny.