Received 25.02.2022; accepted 09.03.2022 An outstanding Soviet surgeon, one of the founders of military field surgery – participant in six wars, Hero of Socialist Labor (1976), academician of the USSR Academy of Medical Sciences (1971), Honored Scientist of the RSFSR (1964), laureate of the Lenin Prize (1961) and the USSR State Prize (1985), Major General of the Medical Service (1953), Professor Ivan Stepanovich Kolesnikov was born on December 2 (15), 1901 in the village of Podosinovka, Novokhopersky District, Voronezh Province. In 1931, he graduated from the Military Medical Academy, in 1932 he entered the adjunct course at the Department of Hospital Surgery of the Military Medical Academy headed by Professor S. P. Fedorov, and in 1936, defended his PhD thesis «Transfusion of conserved blood». During the Great Patriotic War, he held the positions of army surgeon and chief surgeon of the Karelian Front. Together with P. A. Kupriyanov, in the period from 1946 to 1955, he published the «Atlas of Gunshot Wounds» in 10 volumes. In 1946, he defended his doctoral dissertation on the topic: «Removal of foreign bodies from the pleural cavity, pleural junctions and indurations, lungs and mediastinum». In 1953, I.S. Kolesnikov was appointed head of the Department and Clinic of Hospital Surgery of the Military Medical Academy, since 1976 – professor-consultant of the Academy. He was the author and co-author of more than 170 scientific papers, including 25 monographs, manuals and textbooks. Under his leadership, 26 doctoral and 43 candidate dissertations were prepared and defended. I.S. Kolesnikov is rightfully recognized as the founder of the national scientific school of thoracic surgery and one of the world luminaries of military field surgery. Academician Ivan Stepanovich Kolesnikov died on May 18, 1985 and was buried at the academic site of the Theological Cemetery in Saint Petersburg.

The OBJECTIVE was to estimate clinical characteristics, diagnostic possibilities of computed tomography, minimally invasive methods of treatment of peripheral benign lung tumors.

MATERIALS AND METHODS. Benign tumors were diagnosed in 311 (8.2 %) patients among 3789 people with bronchopulmonary neoplasms. A comparative assessment of the results of diagnostics and treatment of two groups of patients was carried out. The first group included 103 patients treated from 2003 to 2009, the second one – 128 patients treated from 2013–2020. 219 (94.8 %) patients were operated on. RESULTS. Benign lung tumors were more often detected at the age of 40-60 years – in 143 (61.9%) patients. The majority (184 patients, 79.6%) had no complaints. In 208 (90 %) patients, tumors were diagnosed during fluorography studies. In the second group, multispiral computed tomography revealed tumors less than 10 mm in size in 38 % of cases. The histological type of tumors was determined during intraoperative express histological test. In the second group, the number of thoracoscopies increased from 2.2 to 43 %, and – thoracotomies decreased from 94.5 to 52.3 %, the number of stapler resections of the lungs doubled, and the number of tumor enucleation decreased by half (p<0.01). Thoracotomy was performed in case of deep tumor localization or large size of the tumor, it was impossible to find it endoscopically. Ten patients underwent lobectomy.

CONCLUSION. Most peripheral benign lung tumors are asymptomatic. Computed tomography revealed tumors less than 1cm in size in 38 % of cases. To rule out malignancy, it is necessary to perform urgent surgery with an intraoperative express histological test. Thoracoscopy allows to remove surface peripheral tumors using the method of stapler resection.

The formation of mediastinal hernias after pneumonectomy may be associated with the development of complications from the remaining lung. The lack of information about the patterns of their development, morphometric characteristics, and dynamics in the postoperative period indicates the urgency of the problem.

The OBJECTIVE was to reveal the topographic and anatomical patterns of the formation of mediastinal hernias after pneumonectomy, to give anatomometric characteristics at various times after the operation.

METHODS AND MATERIALS. Computed tomography of the chest of 53 patients (50 men and 3 women) aged 39 to 75 years before and after pneumonectomy (26 on the left, 27 on the right) were examined. Computed tomography was performed on the 10–12th day, 6 and 12 months after surgery. The transverse size of anterior and posterior mediastinal hernias after left- and right-sided pneumonectomies, their dynamics, and density of lung tissue in the hernial protrusion area were studied. 3D was performed – modeling of the remaining lung. RESULTS. Hernial protrusions were visualized in patients with atelectasis of the lung part before surgery. 10 days after left pneumonectomy, anterior and posterior mediastinal hernias were visualized in 80.8 % of patients. One year after left surgery, anterior hernias were observed in 91.7 % of patients, they increased in size and the average size was (57.3±5.2) mm at the ThV–VI level. Posterior mediastinal hernias 12 months after left pneumonectomy were found in 80.5 % of patients, the average size was (34.9±5.2) mm at the ThVIII level. After right pneumonectomy in the early postoperative period, anterior mediastinal hernias occurred in 70.3 % of patients, a year later-in 88.2 %, the average size was (41.0±7.6) mm at the ThV level. The average transverse sizes of anterior mediastinal hernias 12 months after left and right pneumonectomies did not differ significantly (P=0.950). Posterior mediastinal hernias after right surgery were found in 20.0 % of patients, the largest size was determined at the ThIX level, with an average of (12.7±5.8) mm. After pneumonectomy, bullous changes occured in the lung tissue of mediastinal hernias.

CONCLUSION. Anterior mediastinal hernias are equally common after left and right pneumonectomy, while the size of the hernias did not differ significantly. Posterior mediastinal hernias after left pneumonectomy occurs in 88.2 % of patients, after right pneumonectomy – in 20 % of cases.

The OBJECTIVE of the study was to reveal the causes of anemia in patients with gastric cancer in the perioperative period.

METHODS AND MATERIALS. The object of the study were 700 patients with gastric cancer who underwent surgical treatment. All patients underwent clinical and biochemical blood test, indicators characterizing iron metabolism in the body (serum iron, ferritin, transferrin), and the level of endogenous erythropoietin during the perioperative period. The comparison group included 20 patients with gastric bleeding of non-neoplastic etiology. Both groups were comparable in age (median was 60 and 62 years old) and hemoglobin level (median Hb 95.3 g/l and 94.5 g/l).

RESULTS. Anemia was diagnosed in 15 % of patients (n=105) in the perioperative period. Mild anemia was more often detected (hemoglobin level 95–110 g/l) – in 47.6 % of patients. Moderate anemia (80–94 g/l) was observed in 24.0 % of patients, severe anemia (65–79 g/l) – in 18.1 % of patients, severe (hemoglobin level below 65 g/l) – in 10.3 % of patients. A strong correlation (r=0.89; P<0.05) was observed between the stage at the tumor process and the severity of anemia. At the same time, no connection was found between the macroscopic form of a stomach tumor and the severity of anemia. The analysis of the indicators of iron metabolism allowed to confirm the true iron deficiency in this category of patients, which was characterized by a decrease in the level of serum iron in patients with gastric cancer to (7.8±1.6) μmol/L (from 4.7 to 8.2 μmol/L). Comparative analysis of the level of endogenous erythropoietin in the group of patients with gastric cancer (n=20) and patients with gastrointestinal bleedings of non-neoplastic etiology (n=20) showed significantly lower values   with a difference of 27.7 % in the first group of patients ((66.9±28.2) mIU/ml versus (95.6±36.7) mIU/ml; P<0.05), which indicated inadequate production of erythropoietin in patients with gastric cancer.

CONCLUSION. The main causes of anemia in patients with gastric cancer in the perioperative period should be considered a true iron deficiency, as well as inadequate production of endogenous erythropoietin.

The OBJECTIVE was to improve the effectiveness of prevention of thrombohemorrhagic disorders in patients with calculous cholecystitis and obstructive jaundice.

METHODS AND MATERIALS. The clinic examined 537 patients operated on for obstructive jaundice. From 2010 to 2015, the prevention of thrombohemorrhagic complications consisted in the determination of risk factors, elastic compression of the lower extremities and the appointment of anticoagulants (1st comparative group). Since 2015, all medical measures have also been carried out taking into account the stages of obstructive jaundice (2nd study group).

RESULTS. When comparing the results, the number of subhepatic abscessed hematomas decreased from 4 (1.6 %) patients in the first group to 2 (0.8 %) in the second, the number of gastric bleedings-from 6 (2.4 %) to 3 (1.2 %), metrorrhagia – from 3 (1.2 %) to 1 (0.4 %), pancreatic necrosis – from 8 (3.2 %) to 5 (1.9 %), pulmonary embolism – from 7 (2.8 %) to 5 (2.0 %), the number of strokes and transient disorders of cerebral circulation – from 5 (2.0 %) to 3 (1.2 %), the number of cardiac arrhythmias in the form of atrial fibrillation-from 3 (1.2 %) to 2 (0.8 %). The incidence of myocardial infarction decreased from 5 (2.0 %) patients to 3 (1.2 %), and the incidence of mesenteric vascular thrombosis decreased from 3 (1.2 %) to 1 (0.4 %). In group 1, 2 (0.8 %) patients had hemobilia.

CONCLUSION. In addition to protocols and standards, the prevention of thrombohemorrhagic complications should take into account the stages of obstructive jaundice. During the period of cholestasis, the prevention of thrombohemorrhagic complications should be used in the same volume as in the absence of jaundice. In hepatocytolysis, it should be performed using the CHA₂DS₂-VASc scale with the HEMORR₂HAGESscale as a safety net. In cholangitis, on the contrary, the main role is assigned to the HEMORR₂HAGESscale.

The OBJECTIVE was to give a molecular genetic foundation of combination therapy in the early postoperative period for peritonitis.

METHODS AND MATERIALS. 70 patients with diffuse peritonitis were studied: the first (n=35) – patients underwent basic treatment, the second (n=35) – combined treatment with the inclusion of Remaxol and laser irradiation. The severity of endotoxemia and oxidative stress, the state of the hemostasis system and the functional status of the liver were determined. Molecular genotyping of the following genes was performed: beta subunits of platelet fibrinogen receptor (T1565C, ITGB3), fibrinogen (G(-455)A, FGB), catalase (-262C/T, CAT), superoxide dismutase (C47T, SOD2).

RESULTS. It was found that the early postoperative period in patients with peritonitis is accompanied by endotoxemia, oxidative stress, impaired functional status of the liver, hypercoagulation and hypofibrinolysis. In patients with conditionally «mutant» genotypes of the studied genes, peritonitis is more severe, the severity of changes in the studied indicators of homeostasis is greater. At the same time, the effectiveness of therapy decreased, the number of complications increased, and the stay of patients in the hospital increased. The early inclusion of Remaxol and laser radiation in basic therapy increases the overall effectiveness of treatment: the severity of endotoxemia and oxidative stress decreases, the functional state of the liver and hemostasis system is restored relatively quickly, and as a result, an improvement in clinical results has been registered (a 37.5 % decrease in the frequency of complications (χ²=3.360, p=0.047) and a reduction in the length of stay of patients in the hospital by 16.6 % (p<0.05)).

CONCLUSION. The inclusion of Remaxol and laser therapy in the early postoperative period in the treatment regimen of patients with peritonitis makes it possible to influence pathogenetically important links of the disease relatively quickly, which improves treatment results. This type of therapy is particularly effective in patients with polymorphic genotypes T1565C and C1565C of the ITGB3 gene.

The OBJECTIVE was to study the state of serum matrix metalloproteinase and their prognostic value in closed spleen injuries in the immediate postoperative period.

METHODS AND MATERIALS. Retrospective analysis of the course of the immediate postoperative period of 126 patients with closed spleen injuries was carried out in this work. They were treated in the emergency surgery department. Taking into account that the main leading factor affecting the immediate postoperative period in such patients is the time factor, i.e. the time of delivery to the medical institution from the moment of injury, we divided all patients into two groups: group A – the time of delivery to the medical institution did not exceed one hour from the moment of injury. This group was divided into two subgroups: А1 – isolated injuries and А2 – combined injuries. The second group, group B, included patients whose delivery time exceeded one hour, which were also divided into two subgroups: B1 – isolated injuries and B2 – combined injuries. During the study, the level of the tissue inhibitor of metalloproteinases-1 (TIMP-1), matrix metalloproteinases-2, -7, -9 (MMPs-2, -7, -9) in blood serum was determined.

RESULTS. As a result of the study, it was found that changes in TIMP-1 and MMPs-2, -7, -9 in blood serum depend on the time of delivery of the patient and the presence or absence of combined lesions.

CONCLUSION. Changes in levels of the tissue inhibitor of metalloproteinases-1, matrix metalloproteinases-2, -7, -9 can be considered as predictors of development of complications and fatal outcomes in patients with closed spleen injuries in the immediate postoperative period. Changes in these indicators depend on the time of delivery of the patient and the nature of the injury. The reduction of the tissue inhibitor of metalloproteinases below 1231 ng/ml is an unfavourable indicator of death.

The OBJECTIVE of the study was to identify factors independently influencing intolerance to early enteral feeding via a nasogastric and nasojejunal tube in patients during the early phase of severe acute pancreatitis.

METHODS AND MATERIALS. An open, randomized, controlled, cohort study was carried out. Out of 64 patients with predictors of severe acute pancreatitis, a cohort with severe form was isolated, in which 16 patients received nasogastric and 15 patients – nasojejunal feeding. The enteral feeding intolerance criteria were: discharge via the nasogastric tube >500ml at a time or >500ml/day compared to total enteral feeding administered during 24 hours, intensified pain syndrome, abdominal distension, diarrhea, nausea and vomiting. Indicators featuring prognostic significance were identified using the logistic regression technique. The null hypothesis was rejected at p<0.05.

RESULTS. The presented findings demonstrate that a more severe multiple organ failure (SOFA – OR – 1.283, 95 % CI 1.029–1.6, p=0.027), the operative day (OR – 4.177, 95 % CI 1.542–11.313, p=0.005) increase while the nasojejunal route of nutrients delivery decreases (OR – 0.193, 95 % CI 0.08–0.4591, p≤0.001) the incidence of large residual stomach volumes. Postpyloric feeding reduces the risk of developing pain syndrome (OR – 0.191, 95 % CI 0.088–0.413, p≤0.001), abdominal distension (OR – 0.420, 95 % CI 0.203–0.870, p=0.002), nausea and vomiting (OR – 0.160, 95 % CI 0.069–0.375, p≤0.001).

CONCLUSION. During severe acute pancreatitis, multiple organ dysfunction, the nasogastric route of enteral feeding delivery, and the fact of a surgery increase independently the risk of developing large residual stomach volumes. In case of severe acute pancreatitis, the nasogastric route of nutrients administration increases the development of such manifestations of enteral feeding intolerance as nausea, vomiting, pain intensification, and abdominal distension. In patients with severe acute pancreatitis, the nasoejunal route of administration of nutrients is preferable.

INTRODUCTION. The article presents the experience of treatment of abdominal aortic aneurysms from 2011 to 2016 using the author’s technology, which contains the method of double strengthening of the neck of the aortic aneurysm, on the basis of the Department of Hospital Surgery in the Department of Vascular Surgery of the RCH of Nalchik.

METHODS AND MATERIALS. According to this method, 202 patients with abdominal aortic aneurysm (group I) were operated on, 116 were admitted as planned, 86 were admitted as emergency and urgent, while 183 were men and 19 were women. Without using the technique of double  strengthening of the aneurysm neck, 205 patients were selected for the period from 2006 to 2011. They were included in group II. Among them, 118 were received as planned, 87 were received in special and urgent cases. The patients were examined thoroughly. CT angiography in 3-dimensional reconstruction was performed using special research methods.

RESULTS. All patients were transferred to the intensive care unit after the operation. In the operative and immediate postoperative periods, among the operated patients admitted in an emergency and urgent, 19 patients with a ruptured aortic aneurysm died in group I, 23 patients – in group II. Among the planned patients, 2 in group II died from a combined severe concomitant pathology. All other patients were activated on the 2nd-3rd day, and subsequently discharged in a satisfactory condition.

CONCLUSION. The advantages of the proposed method of surgical treatment of abdominal aortic aneurysm are: technical simplicity of execution, double strengthening of the neck of the aneurysmal sac, tightness of the anastomosis, therefore, the reduction of intraoperative blood loss, the possibility of performing aortic prosthetics with suprarenal and renal aneurysms and weakness of the wall in the neck area in the absence of an artificial circulation apparatus.

The OBJECTIVE was to evaluate the results of the developed measures for the prevention of the residual cavity in liver echinococcectomy.

METODS AND MATERIALS. The patients were operated on in the surgical departments of the City Clinical Hospital ¹ 1 in Bishkek in 2017–2018. The article presents the results of observation of 95 patients operated on for liver echinococcosis without complications of biliary fistulas. The developed measures for the prevention of complications were used in the work. There were 2 groups (control and main). In the control group (63 people), organ-preserving operations were performed using traditional methods to eliminate the cavity of the fibrous capsule. In the main group (32 people), the same elimination methods were performed, but supplemented with the use of a hemostatic collagen sponge to prevent the occurrence of a residual cavity, and they also affected the area of the surgical wound with infrared irradiation to prevent inflammatory complications.

RESULTS. In the control group, when performing capitonage and invagination, the residual cavity was detected in 5 patients, of which 3 developed suppuration. During pericystectomy, residual cavity and bile leakage occurred in 1 case, reactive pleurisy – in 4 cases. In the control group, the residual cavity required puncture, and in 3 patients, a second operation was performed – open drainage of the festering cavity. Thus, the occurrence of residual cavity was 9.5 %, other complications – 7.9 %. In the main group, with the use of preventive measures of capitonage and invagination, the residual cavity was detected in 2 (6.3 %) cases of small size, without the presence of exudative-inflammatory phenomena, and during pericystectomy, the occurrence of a cavity and wound complications were not detected.

CONCLUSION. The application of the developed measures to prevent the occurrence of a residual cavity and inflammatory complications with the use of a hemostatic collagen sponge during capitonage and invagination made it possible to reduce the number of complications by 1.5 times. There were no complications associated with pericystectomy.

INTRODUCTION. Patients with peritonitis complicated by severe sepsis and septic shock determine the mortality rate of a general surgical hospital. The role and place of the Damage control technique in this category of patients remain debatable.

The OBJECTIVE was to analyze the use of tactics of staged surgical treatment in patients with peritonitis and septic shock.

METHODS AND MATERIALS. On the base of the Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, we conducted a prospective randomized study of the effectiveness of various approaches to the treatment of patients with non-traumatic peritonitis and septic shock, who, after elimination of the primary source, need to restore intestinal continuity. The study included 37 patients, their mean age was (69±14) years, women were 19 (51 %). The patients were divided into 2 groups: the study group (n=14) included patients treated with the Damage Control (DC) principle, in the comparison group (n=23), primary surgery was performed in full. Both groups are representative in terms of demographics, comorbidity, severity of peritonitis and organ dysfunction.

RESULTS. The groups differed significantly in the duration of preoperative preparation (p=0.028) and surgery (p=0.025). Mortality rate among patients who used DC tactics was 2 times lower (35.6 vs. 73.9 %) (p=0.038). When assessing the indicators of systemic hypoperfusion, a difference was noted in the dynamics of lactate (p=0.048) and INR (p=0.007) values   during the first three days of the postoperative period. Accordingly, in patients who underwent staged treatment, there was a positive dynamics in SOFA values   (p=0.049) from the 3rd day, and by the 7th day of the postoperative period in most patients, this indicator did not exceed 2 points (p=0.048). During staged surgical treatment, a constant increase in the Horvitz index was recorded from the second day of the postoperative period, while in the control group, the dynamics of this indicator was negative (p=0.041).

СONCLUSIONS. Damage control tactics is safe and can be used in the treatment of general surgical patients with non-traumatic peritonitis and septic shock. Reducing the duration of preoperative preparation, reducing the volume of surgical intervention and, consequently, the duration of the operation allow reduce the time for eliminating signs of systemic hypoperfusion and organ dysfunction, which reduces the rate of death.

The clinical case of treatment of the patient with gallstone disease complicated by phlegmonous calculous cholecystitis, choledocholithiasis, obstructive jaundice and purulent cholangitis is presented. The combination of such dangerous complications requires urgent surgical treatment, the minimum amount of which is cholecystectomy and bile duct external drainage at the first stage of treatment. In this case, the simultaneous elimination of choledocholithiasis was considered unjustifiably traumatic and not rational due to the large size of the concretion (13 mm). We also decided to refuse the wide endoscopic papillosphincterotomy. At the second stage of treatment, under the control of transpapillary choledochoscopy, nanoelectroimpulse choledocholithotripsy was performed with the destruction of a dense concretion of choledochus without damaging the surrounding tissues and the sphincter apparatus of the large papilla of the duodenum, which eliminates the likelihood of complications arising after papillosphincterotomy.

INTRODUCTION. Intrathoracic esophageal postoperative suture’s failure occurs in 8–26 % after distal esophagectomy and 3–12 % after total gastrectomy, also this leads to the development of life-threatening complications and a rather high mortality rate. Endoscopic vacuum therapy is an actively developing and modern method of treating defects in the wall of hollow organs.

CINICAL EXAMPLE. 9-year-old patient had resection of the esophageal wall for an enterogenic cyst. The failure of the postoperative suture was clinically diagnosed after the 1st day of operation, confirmed by endoscopic and X-ray findings. We decided to use endoscopic vacuum therapy with Suprasorb sponge. The sponge was replaced at intervals of 3–5 days. On the 9th twenty-four hours after the operation, a delimited cavity into the mediastinal pleural space with a length of 8 cm and a width 1.5 cm with fibrin deposits on the walls was diagnosed.  The size and shape of the sponge depended on the size of the defect of the esophageal wall and the volume of the delimited cavity. Conservative and rehabilitation therapy was also carried out. On the 40th day after the operation, complete epithelialization of the esophageal wall defect was noted. The patient was discharged in a satisfactory condition. Due to the results of our clinical observation, we reached a conclusion that endoscopic vacuum therapy is applicable in clinical practice, because it is an effective method of treatment for the of intra-thoracic esophageal suture’s failure. The technique is relatively safe, contributes to the complete elimination of the full-wall defect, reducing the period of social recovery and maintaining a high quality of life after treatment.

Ewing’s sarcoma is a malignant bone tumor. It occurs more often in teenagers between 10–15 years old and metastasizes to the lungs and nervous system. Heart disease is atypical and occurs in only a few cases. We present a clinical case of late diagnosis of Ewing’s sarcoma in a 26-year-old patient with metastases in the left side of the heart. According to instrumental tests, hypermobile, ribbon-like formations were visualized on the cusps of the aortic and mitral valves with damage to the chordal apparatus. Coronary angiography was performed with embolextraction from the middle third of the left anterior descending artery and its diagonal branch, due to the clinical picture of anterior acute myocardial infarction with ST segment elevation. An urgent cardiac surgery was performed, in the attempt to prevent fatal incidents. During the revision, in addition to damage to the aortic and mitral valves of the heart, metastatic masses grew into the layer of the myocardium, the removal of which is technically impossible.In the early postoperative period, the patient died due to embolization into the brain and coronary arteries. Diagnosis of Ewing’s sarcoma requires timely diagnosis and treatment in order to prevent the rapid spread and development of life-threatening and fatal complications.

INTRODUCTION. The main component of the treatment of patients with secondary diffuse peritonitis is surgical intervention aimed at controlling the source of infection. In some cases, a single intervention is not enough for effective sanation of the abdominal cavity, which requires relaparotomy. There is currently no generally accepted approach to the timing and order for such interventions. The OBJECTIVE was to carry out a comparative analysis of the immediate results of patients with secondary diffuse peritonitis treatment using strategies of planned and «on-demand» relaparotomies.

METHODS AND MATERIALS. The inclusion criteria for the review were randomized and cohort controlled trials comparing the efficacy of planned and «on-demand» relaparotomies in the treatment of secondary diffuse peritonitis. Primary sources comparing the results of these surgical strategies in adult patients were searched using the CENTRAL, MEDLINE, Scopus and eLibrary databases. The studies were independently assessed for inclusion by two review authors according to the stated eligibility criteria followed by data extraction. The methodological quality of randomized trials was assessed using the Cochrane tool for assessing the risk of bias, nonrandomized ones – using the Russian version of the Newcastle-Ottawa scale. Arising disagreements were resolved through discussions.

RESULTS. The review included one randomized controlled trial according to the inclusion criteria and 16 nonrandomized cohort studies with a total of 3672 participants (1835 and 1837 patients undergoing planned and «on-demand» relaparotomies, respectively). Given the significant statistical heterogeneity of the included studies (χ2=119.2, df=16, p<0.00001, I2=87 %), a random effects model was used to assess the intervention effect: the resulting risk of death ratio was 0.68 (95 % CI 0.42–1.10) in favor of planned relaparotomies. The assessment of the systematic review sensitivity, performed by changing the inclusion criteria, showed a similar conclusion: the risk of death ratio was 0.79 in favor of the planned relaparotomies (95 % CI 0.46–1.36).

CONCLUSION. The obtained data demonstrated the presence of a statistically insignificant (p=0.11) decrease in postoperative mortality rate in the subgroup of patients with planned relaparotomies. Given the average risk of systematic and significant risk of publication bias in the included studies, these conclusions should be accepted with caution. Further studies in the format of randomized trials will undoubtedly increase the level of the evidence reliability.

Percutaneous endoscopic gastrostomy is the most common method for enteral nutrition in intensive care patients with dysphagia syndrome. The advantages of the method are the minimally invasive nature and duration of the operation, which also determines a small percentage of postoperative complications. There are many literary sources devoted to the most common complications, indications and contraindications to the procedure. The objective of the literature review was to analyze the data on the relative contraindications to percutaneous endoscopic gastrostomy and the tactics used by specialists to minimize the risks of performing surgery in this group of patients. Correction of the general condition and concomitant somatic diseases in the patient as well as a thorough risk assessment have the greatest impact on the immediate results of the operation.

The article is devoted to Dieulafoy syndrome, a rare pathology that manifests itself by intense bleeding from a defect of abnormally dilated vessels of the submucosal layer of the stomach. The article discusses the main methods of diagnosis, treatment and prevention of Dieulafoy syndrome, lists the synonyms of «Dieulafoy syndrome». A brief historical reference is given. The definition of the concept of «Dieulafoy syndrome» is given. The age and gender prevalence of this syndrome is analyzed. Variants of localization of the lesion in this syndrome are described. The main causes and risk factors for the occurrence of Dieulafoy syndrome are highlighted. The most common clinical manifestations are characterized. The advantages and disadvantages of various methods of diagnosis of Dieulafoy syndrome are described. Special attention is paid to the diagnosis and criteria for endoscopic verification of this syndrome. Various methods of treatment have been investigated: conservative, endoscopic and operative. The indications and contraindications to each of the treatment methods are described, as well as their advantages and disadvantages. Possible combinations of various methods of endoscopic hemostasis are listed. The question of choosing the optimal combination of different methods of endoscopic hemostasis is highlighted. Risk factors for recurrence of bleeding have been determined. The frequency of recurrence of bleeding in Dieulafoy syndrome was analyzed. A number of unresolved issues related to the diagnosis and treatment of this syndrome have been identified, such as issues of effective prevention and prediction of recurrent bleeding.