Professor Nikolai Nikodimovich Malinovsky was born on January 1, 1921 in the village of Zheltki, Vileisky district, Minsk region of Belarus, in a peasant family. In 1944, N. N. Malinovsky entered the Minsk Medical Institute and in 1948 graduated with honors. In 1954, he defended his thesis «Experimental observations during cardiac probing and angiocardiography». In 1957, he came to the Department of Hospital Surgery of the 1st MMI named after I. M. Sechenov at the invitation of B. V. Petrovsky, elected head of this Department. In 1964, N. N. Malinovsky defended his doctoral dissertation «Thrombosis of the left atrium and its ear in patients with mitral stenosis». In 1965, he was elected professor at the Department of Hospital Surgery of the 1st MMI, and in 1970, he became the head of the clinical department of the All-Union Research Institute of Clinical and Experimental Surgery of the Ministry of Health of the USSR (now FSBNU «Russian Scientific Center of Surgery named after acad. B. V. Petrovsky». N. N. Malinovsky’s scientific research was devoted to topical surgical problems, primarily cardiac surgery. One of the first in our country, he successfully performed embolectomy from the pulmonary artery. In addition, he was the author and co-author of more than 400 scientific papers, including 7 monographs, a practical guide to surgical diseases, one of the sections of the «Atlas of Thoracic Surgery», and a co-author of the monograph widely known among cardiovascular surgeons «Emergency Heart and Vascular Surgery» (edited by B. V. Petrovsky and M. E. DeBeiki). Academician N. N. Malinovsky – laureate of two State Prizes of the USSR (1985, 1987) and the Prize of the Russian Academy of Sciences named after A. N. Bakulev (2007), Honored Scientist of the Uzbek SSR (1979). For more than 25 years, Nikolai Nikodimovich worked as editor-in-chief of the journal «Surgery named after N. I. Pirogov», and also for many years was a member of the editorial board of the journal «Vestnik RAMS». Academician N.N. Malinovsky died on January 24, 2018 and was buried at the Troekurovsky cemetery in Moscow.

Introduction. Cysts of the chiasmo-sellar region include Rathke cleft cysts, colloid cysts, arachnoid cysts, dermoid cysts, and epidermoid cysts.

The objective was to determine the specific features of surgical treatment for each type of cysts of the chiasmo-sellar region, allowing to achieve the best postoperative results.

Methods and materials. During the period from 2009 to 2018, 57 patients with cysts of the chiasmo-sellar region were examined and treated. All patients underwent transsphenoidal endoscopic treatment of cysts of the chiasmo-sellar region.

Results. Among 57 operated patients, follow-up observation revealed only 2 relapses.

Conclusion. For each type of cysts of the chiasmal-sellar region, there are specific features of surgical treatment that allow to achieve the best postoperative results.

The objective was to evaluate the immediate results of treatment of patients with symptomatic form of myocardial bridges of the coronary arteries.

Methods and materials. In the course of a retrospective study, the results of treatment of 70 patients who had underwent drug treatment and 52 patients who had underwent surgical treatment were analyzed. All the subjects had high functional angina pectoris.

Results. Pharmacological therapy showed significant positive dynamics in 18 (25.7 %) patients. Analysis of the intraoperative and early postoperative periods in patients who underwent supracoronary myotomy allows us to conclude that surgical treatment of patients with myocardial bridges of the coronary arteries shows satisfactory results.

Conclusion. Drug therapy may be effective in some patients with myocardial bridges of the coronary arteries. In case of ineffectiveness of pharmacological treatment, the possibility of performing surgery in the amount of supracoronary myotomy should be considered.

Introduction. Currently, traditional methods and minimally invasive surgical technologies are used in the treatment of celiac trunk compression syndrome. The choice of treatment method remains a subject of discussion. The drawback of the classical approach – laparotomy – is a significant trauma to the tissues of the abdominal wall, the risk of adhesions, wound infection and hernias. The disadvantage of videosurgical techniques is the risk of developing life-threatening bleeding requiring conversion of access. The main cause of this complication is damage to the wall of the aorta, celiac trunk and its branches during the intervention.

Methods and materials. A set of tactical and technical principles was developed to reduce the risk of bleeding during laparoscopic decompression of the celiac trunk. The prerequisites were an assessment of the individual architectonics of the vessels according to 3D reconstruction data, the location of working instruments as parallel to the celiac trunk course, retrograde access to the compression zone, the use of an ultrasonic or bipolar dissector, contact with the vascular wall only with passive branches. With these principles surgical intervention was performed in 12 patients.

Results. Complication (bleeding from the branch of the lower phrenic artery) – occurred in one (8.3 %) case – was eliminated laparoscopically. The average duration of the operation was 85 minutes, the average hospital day after the operation was 5 days. Treatment results within 3 to 12 months were evaluated in 8 out of 12 (66.7 %) patients. In 7 (87.5 % of patients with the studied results) cases, complete regression of symptoms and restoration of normal blood flow were noted. One (12.5 %) person had a slight abdominal pain syndrome against the background of normal hemodynamics in the celiac trunk.

Conclusion. The presented data are comparable with the results of traditional surgical methods of treatment of celiac trunk compression syndrome and are the basis for further research.

The objective was to improve the results of treatment of patients with persistent defects of the anterior tracheal wall and soft tissues of the neck.

Methods and materials. 220 patients with tracheal cicatrical stenosis were treated, of which 120 patients had defects of the anterior tracheal wall of various sizes. In 70% of cases, PCT was postintubation/posttracheostomy. Men predominated – 89 (74.2 %), women – 31 (25.8 %). After a routine examination, including endoscopic examination, MSCT of the chest with the capture of the cervical region, and general clinical diagnostic methods, all patients underwent surgical treatment.

Results. According to the nature of the elimination of the defect of the anterior tracheal wall, patients were divided into several groups. Both local plastic surgery and the elimination of the tracheal defect with the use of microsurgical techniques were used. Circular resection of the trachea with the elimination of the defect was performed in 5 cases. In 2 cases, in the presence of a large persistent defect of more than 6 cm in size, a composite pre-fabricated deltopectoral skin-fascial-cartilage flap was used.

Conclusion. The choice of a method for eliminating a persistent open defect of the anterior tracheal wall is determined individually in each case, it depends on its size, the depth of the airway lumen, and the condition of the surrounding tissues. The use of displaced skin-fascial flaps on the vascular pedicle for closing the tracheal defect allows to restore the mucous membrane of the tracheal defect area without using the surrounding scar tissue and close the defect with a second flap without straining the edges of the wound.

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.

Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.

Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.

Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

Introduction. At present, high-resolution esophageal manometry is the «gold standard» for the diagnosis of esophageal achalasia, based on the determination of the integrated relaxation pressure of the lower esophageal sphincter, the value of which in the case of achalasia must exceed 15 mm Hg (MMS System). However, in some patients with clinically and radiologically confirmed achalasia, this value is normal. There is no unified view of the cause of this phenomenon. We assumed that low pressure figures may be affected by incorrect installation of the manometric catheter.

Methods and materials. This research included 149 patients (61 by retrospective estimating the patients data and 88 new patients) with achalasia established during the period from January 2017 to March 2020. When it was impossible to localize the lower esophageal sphincter and take correct measurements during high-resolution manometry in new patients, the X-rays or upper endoscopy was performed to control the manometric catheter placement. If its’ placement was incorrect and the integrated relaxation pressure level was lower than 15 mmHg, repeated high-resolution manometry was performed with the over-the-guidewire manometric catheter placing.

Results. In 36 patients of both groups (24.2 %), the manometric data did not correspond to esophageal achalasia; in the prospective group, 12 out of the 19 patients had incorrect manometric data due to inability to visualize lower esophageal sphincter. In the prospective group, the manometric catheter was reinstalled by a guidewire, which allowed visualizing the signs of the lower esophageal sphincter in all cases, and in 15 out of 19 patients (79 %), the integrated relaxation pressure of the lower esophageal sphincter was more than 15 mm Hg.

Conclusions. In some cases, the over-the-guidewire installing makes it possible to pass catheter through the lower esophageal sphincter correctly, visualize the lower esophageal sphincter during the high-resolution manometry examination and obtain true pressure values.

The objective was to analyze the long-term results of open aorto-femoral reconstructions in order to optimize the approach to surgical treatment.

Methods and materials. The study included 548 patients with reconstructions of the aorto-femoral segment performed between 1999 and 2007. Of these, 293 patients underwent loop endarterectomy of the iliac arteries, 255 – after aorto-femoral bypass with a synthetic prosthesis. All interventions were performed against the critical lower limb ischemia. The superficial femoral arteries remained occluded in all cases. Outflow was carried out only in the deep femoral arteries and collateral vessels. Patients were under clinical supervision for 5 to 20 years. In the long-term period, most patients underwent interventions on the coronary, brachiocephalic arteries, as well as surgery for cancer.

Results. Timely correction of concomitant pathology made it possible to increase the survival rate of patients by the 10-year follow-up period to 72 %, and after 20 years this figure reached 63 %. The primary patency of the reconstructed segment after loop endarterectomy was significantly higher than after aorto-femoral bypass surgery. Secondary patency in the groups did not significantly differ and by 20 years of follow-up reached 76 %. A high level of patency of the operated segment was also provided by a large percentage of preserved limbs (80 % after 20 years). A study of the quality of life showed that, despite the persistence of intermittent claudication at the level of 400–800 meters, the vast majority of patients were satisfied with their life. Suppurations in the transplant area and the formation of false aneurysms in the area of anastomoses were found only in the group of aorto-femoral bypass grafts.

Conclusion. Open reconstructive operations on the aorto-femoral segment, such as loop endarterectomy and aorto-femoral bypass with adequate postoperative medical examination have good long-term results of survival, patency of the reconstructed segment, percentage of saved limbs and quality of life of patients. Complications in the form of suppuration in the transplant area and the formation of false aneurysms occur only after bypass.

The objective was to improve the surgical treatment tactics in patients with non-small cell lung cancer (NSCLC) and coronary heart disease (CHD), requiring myocardial revascularization.

Methods and materials. Two groups consisting of 24 patients operated on for NSCLC were examined. In one group, operations for NSCLC were performed in the second stage after coronary artery bypass grafting (CABG). Survival rates in both groups and factors influencing them were evaluated.

Results. The number of postoperative complications in both groups was comparable: 20.8 % in patients with CABG and 16.6 % in the group operated only for NSCLC. Indicators of relapse-free and overall survival did not differ significantly from each other (p=0.90 and p=0.95). Only the stage of the disease (p=0.009) and the implementation of complex cancer treatment in case of its necessity (p=0.035) had a reliably impact on the long-term results of the operation. The first stage of myocardial revascularization surgery did not affect the results of treatment (p=0.94), as well as the age of patients, the volume of performed surgery, the morphological picture of the tumor.

Conclusion. The staging approach to the treatment of patients with NSCLC and critical forms of CHD requiring myocardial revascularization is reliable, convenient and does not affect the long-term results of treatment.

The objective was to study the prevalence of erosive and ulcerative gastroduodenal lesions, bleedings of this localization and the relationship with factors predisposing to them in patients with critical lower limb ischemia and type 2 diabetes mellitus who underwent endovascular intervention for limb revascularization.

Methods and materials. The study included 81 patients aged 67.5±6.8 years, hospitalized in the department of vascular surgery with critical lower limb ischemia of atherosclerotic genesis and type 2 diabetes mellitus to perform revascularization by means of transluminal balloon angioplasty with stenting when indicated. In the preoperative period, all patients underwent fibrogastroduodenoscopy, according to the results of which a scoring assessment of the lesion of the gastric mucosa and duodenum was presented.

Results. All patients participating in the study were diagnosed with pathology of the gastroduodenal zone: in 95.1 % of the inflammatory nature, in 4.9 % of the ulcer. The relationship between the duration of rest pain, the fact of damage to the mucous membrane of the upper gastrointestinal tract and its severity was not revealed, but the relationship of erosive and ulcerative lesions of the stomach and duodenum with the number of taken pain pills was determined. In patients with repeated endovascular intervention and / or amputation, gastrointestinal bleedings were more often recorded compared with study participants who underwent a single revascularization – 11.1 and 1.6 % of patients, respectively.

Conclusion. Erosive and ulcerative lesions of varying severity are present in all patients with critical lower limb ischemia on the background of diabetes mellitus. At the same time, patients with repeated endovascular interventions and / or amputations are more susceptible to bleeding. For the prevention of pathology of the stomach and duodenum, an in-depth diagnosis and a differentiated approach are required.

Introduction. Among patients with primary and postoperative ventral hernias, obesity of various degrees is observed in more than 50 % of patients. A severe complication of obesity is the development of panniculus – a skin-subcutaneous apron of varying severity. The hernia surgeon often performs a panniculectomy, which requires justification, taking into account both the positive and negative consequences.

The objective was to improve the results of treatment of patients with hernias who are obese by developing a mathematical algorithm of indications for removing the skin-subcutaneous apron.

Methods and materials. The analysis of surgical treatment of 253 obese patients with hernia aged 20 to 90 years was performed. There were 44 males (17.4 %) and 209 females (82.6 %). There are 2 groups: the first (comparison group) included 129 patients whom the hernia excision was performed without removing the skin-subcutaneous apron; the second (main group) – 124 patients who had the excision of the skin-subcutaneous apron during surgery. Indications for panniculus removal were based on the proposed mathematical algorithm, which took into account the size, clinical manifestations, associated complications, and possible consequences after surgeries while preserving it.

Results. When considering the abdomen in patients with hernias and obesity from the side surface, the hanging apron in relation to the abdominal wall forms a truncated cone, or two conjugated cones that form significantly different moments of forces acting on the abdominal wall at different stages of development of the panniculus, and, therefore, can serve as the basis for the development of classification. Based on this mathematical model, the following classification of changes in the anterior abdominal wall in hernias and obesity is proposed: saggy belly; cutaneoussubcutaneous apron I, II, III degrees, which are based on calculated mathematical indicators and clinical manifestations of the disease. When treating patients with hernias and obesity during operations, the following tactical algorithms were followed: with a saggy stomach and panniculus of the 1st degree, the removal of the skin-subcutaneous apron can be refused; with the 2nd and 3rd degrees, its preservation contributes to the recurrence of the hernia due to the action of moments of forces that shift and pull the abdominal wall down.

Conclusions. Clinical observations of patients with hernias and obesity have shown that the removal of the skinsubcutaneous apron did not lead to an increase in the frequency of wound and systemic complications, and therefore it should be considered a necessary stage of surgery.

The objective was to retrospectively analyze the dependence of long-term results of laparoscopic Roux-en-Y gastric bypass surgery according to the size of the formed gastric stump

Methods and materials. We retrospectively analyzed the long-term results of 207 morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by two different techniques. The median follow-up was 36 months. Two groups of patients were identified according to the method of formation of the gastric stump: using 2 (1^st group) or 3 (2^nd group) stapler cassettes and performing of computed tomography volumetry to determine the

volume of the created gastric stump.

Results. Statistically significant differences in the volume of the formed gastric stump, depending on the method of operation, were as follows: 23.8 ml (8.9–37.3 ml) in the 1^st group and 47.7 ml (31.9–72.8 ml) in the 2^nd group (p<0.0001). Significant differences were observed in the following indicators: relapse of weight gain or insufficient weight loss (loss of < 70 % overweight) at median follow-up of 36 months were observed in 2 (2.3 %) and 12 (9.9 %) cases in the 1^st and 2^nd groups, respectively (p<0.05).

Conclusion. We revealed that the formation of the gastric stump of a very small volume by 2 stapler cassettes compared to using 3 stapler cassettes contributes to improving the results in the long-term postoperative period and minimizing the frequency of relapse of weight gain and insufficient weight loss. The restrictive component of the surgery with equal malabsorptive is fundamental for the clinical parameters of its effectiveness, that leads to increasing the frequency of relapses of weight gain and insufficient weight loss in the 2^nd group in comparison with the 1^st and group of patients (p<0.05). Based on computed tomography volumetry, the volume of a small-sized stomach stump can be reliably measured and, accordingly, weight loss is predicted in the long term after the surgery, as well as the absence of relapses of weight gain or insufficient weight loss.

The publication presents the successful experience of using the DaVinci robotic system for the treatment of persistent hyperparathyroidism caused by mediastinal ectopic parathyroid adenoma in 62 years old female patient. The role of single photon emission computed tomography in diagnostics was demonstrated.

In the issue the authors report brief literature review and the case of use of bivalirudin as an alternative intraoperative anticoagulant for endovascular abdominal aortic aneurysm repair in a patient with heparin-induced thrombocytopenia.

These two cases of successful treatment of a rare vascular disorder – cystic adventitial disease (CAD). Case 1: CAD of the popliteal artery with narrowing of the popliteal artery and intermittent claudication. Case 2: CAD of iliac vein with irreducible femoral hernia formation and iliac vein subocclusion. We described preoperative planning, surgical intervention and postoperative management in our cases. Surgery after careful preoperative planning is only one effective method of treatment of CAD and has good long-term results.

Rectal wound occurs in 1 to 5 % of cases among wounds of the abdominal organs. In patient B., 32 years old, 3 days after a stab wound to the left gluteal region and after ligation of the internal iliac artery with an extraperitoneal approach to stop ongoing bleeding, rectoromanoscopy and chromovulneroscopy revealed damage to the rectal wall measuring 1.2×0.7 cm at a height of 15 cm from the anus. The defect in the rectal wall was closed using endoscopic clips (6 pcs.). The wound canal of the left gluteal region was overdrained. At the control examination of the rectum on the 20th day after suturing the defect with endoscopic clips, the intestinal wall was sealed. The wound in the gluteal region healed by secondary intention. The patient was discharged from the hospital after 3 weeks. This method of endoscopic clipping of a rectal wound with external drainage of the wound canal is a modern minimally invasive method of treatment and can be used as an alternative to sigmoidostomy. The obvious advantages of this method of treatment are: improving the patient’s quality of life, the absence of the need for additional surgical interventions in order to restore the continuity of the colon.

Radiation proctitis is a rare and significant complication of the combined therapy in patients with pelvic cancer. The choice of treatment of chronic radiation proctitis depends on the stage of disease and recurrent rectal bleeding. Comorbidity is cause to complicated proctitis. These clinical cases describe the choice and sequence of surgical interventions in order to achieve successful results in patients with chronic radiation proctitis.

Injuries of abdominal and retroperitoneal major blood vessels are the most severe injuries. Delayed diagnosis, irrational accesses and methods of temporary hemostasis aggravate the severity of the condition and lead to life-threatening complications. The objective was to summarize the data from Russian and foreign literature for improving the results of treatment of patients with injury of abdominal and retroperitoneal major vessels. The article discusses the etiology, clinic, diagnostic algorithm for abdominal vascular injury and treatment of patients with injury of abdominal arteries, describes the methods of temporary and final hemostasis. It is necessary for a general surgeon to know the therapeutic and diagnostic algorithm for vascular injury, rational accesses to them and methods of temporary and final hemostasis, as well as the principles of «damage control» tactics to save the life of the patient.

The article provides an analysis of the literature on the frequency and nature of postoperative complications in patients infected with a new coronavirus infection – COVID-19. Risk factors for the development of postoperative complications and mortality are considered; the presence of SARS-CoV-2 is a leading risk factor for these complications and mortality, significant risk factors are also patients age ≥70 years, male gender, cancer surgery, severity of the patient’s condition before surgery (3–5 points on the ASA scale), performance emergency operations, a significant amount of surgical interventions. Postoperative complications in patients with COVID-19 develop in 50 %, the mortality rate is 2 times higher compared with patients without coronavirus infection.

A. N. Vedensky was born on December 6, 1931 in a family of employees. Relatives and family members of A.N. Vedensky, by their merits to the motherland had a significant impact on his development as a doctor and teacher. He excellently graduated from the paramedic school in Bobruisk and the First Medical Institute of Leningrad named after Academician I. P. Pavlov. After graduation, the Institute sent him to Velikiye Luki, Pskov region, where he worked in regional and city hospitals, at an ambulance substation. In 1960, he entered and went to study at the postgraduate course of the Institute of Blood Transfusion (LPIK) in Leningrad.