Outstanding pediatric surgeon, scientist, teacher and health care organizer, founder of a large school of pediatric surgeons, Honored Scientist of the RSFSR (1973), academician of the USSR Academy of Medical Sciences (1975) and the Russian Academy of Sciences (2013), vice-president of the Russian Academy of Medical Sciences (1989–2001), laureate of two State USSR Prizes (1979, 1985) and the State Prize of the Russian Federation (1999), Chief Pediatric Surgeon of the USSR Ministry of Health (1966–1981) and the Russian Ministry of Health (1992–2005), Deputy Minister of Health of the USSR (1981–1987), Professor Yuri Fedorovich Isakov was born on June28, 1923 in Kovrov, Vladimir region. In 1966, he was elected head of the department of surgical diseases of childhood at the 2^nd Moscow Medical Institute named after N. I. Pirogov and led it for 40 years. The surgical and scientific activities of Yuri Fedorovich were distinguished by a very wide range of areas. On the problems of thoracic surgery, extensive experience has been accumulated in the treatment of children with diseases and malformations of the neck, chest, lungs, mediastinum, and esophagus. Many diverse research works have been carried out on topical issues of abdominal surgery. Yu. F. Isakov made a very large contribution to the development of endovideosurgery in children. The clinic became one of the first in the country to create a specialized endovideosurgical service. Under the leadership of Yuri Fedorovich and with his direct participation, pediatric nephrurology and vascular surgery quickly developed, scientific research was conducted on topical issues of combined trauma of the musculoskeletal system, an anesthesiology, resuscitation and intensive care service was organized in the clinic, fundamental research was carried out on the problem of pain management in children surgery. Yu. F. Isakov was the author and co-author of more than 500 scientific works, including 23 monographs and manuals, 7 textbooks and teaching aids. At the department headed by Yuri Fedorovich, 390 dissertations were defended, including 67 doctoral dissertations. Academician Yuri Fedorovich Isakov died on August 4, 2016 and was buried at the Troekurovskoye cemetery in Moscow.

INTRODUCTION. Isolated sphenoid sinus disease is a rare condition due to the topographic location of the sinus. In complicated cases and the occurrence of a chronic course, the main method of treatment is surgical cure. There are different approaches to the main sinus, the most effective and safest is endoscopic endonasal sphenotomy. However, in cases of anomalies or disorders of the development of the sphenoid sinuses, as well as the need for combined operations, the transeptal approach may be the method of choice.

OBJECTIVE is to evaluate the effectiveness and security of the proposed access.

METHODS AND MATERIALS. A prospective analysis was carried out of 52 patients who underwent surgical treatment of isolated sphenoiditis at the Clinic of Otorhinolaryngology of the Pavlov State Medical University in the period from 2018 to 2023.

RESULTS. In 5 cases, the sphenoid sinus was opened by transseptal approach. As a result of the analysis of the two approaches, no statistically significant differences were found.

CONCLUSIONS. Our surgical interventions with transseptal approach in patients with minor sphenoid sinuses, impaired course of the internal cerebral artery, as well as the need for simultaneous correction of the nasal septum revealed the advisability and effectiveness of approach in such situations, as well as its safety in relation to neurovascular structures.

INTRODUCTION. The relevance of treating patients with hernias of the anterior abdominal wall is beyond doubt, since the incidence of the disease is on average 5 people per 1000, and hernioplasty itself is one of the most common operations in a general surgical hospital. However, the relapse rate remains quite high. There remains a debate about the choice of surgical option; the issues of prevention and treatment of pain syndrome, as well as tactics for managing patients with a complicated postoperative period, remain unresolved.

The OBJECTIVE was to evaluate the effectiveness of the modern concept of treating patients with ventral hernias and to substantiate the principles for choosing a hernioplasty technique.

METHODS AND MATERIALS. The study is based on the results of treatment of 1938 patients operated on at the Faculty Surgery Clinic named after S.P. Fedorov Military Medical Academy in the period from 2015 to 2022. Both open and endovideosurgical options for surgical interventions were performed for isolated umbilical hernias or in combination  with diastasis of the rectus muscles, hernias of the white line of the abdomen, inguinal and postoperative hernias, including reduction of the volume of the abdominal cavity.

RESULTS. During the study, an algorithm for the treatment of patients with ventral hernias was developed, various options for perioperative pain relief were proposed, and the tactics for treating infectious and purulent complications were substantiated.

CONCLUSION. A specialized surgical hospital must perform all possible options for both traditional and endovideosurgical hernioplasty, use innovative options for pain relief in the perioperative period, and apply modern methods for diagnosing and treating postoperative complications in order to provide personalized medical care.

The OBJECTIVE was to study changes of IL-6 concentration in the blood and bile in patients with MJ of tumor genesis by means of biliary sorption.

METHODS AND MATERIALS. The investigation was conducted to study changes in the concentration of IL-6 in the blood and bile against the background of bile sorption in 105 patients with mechanical jaundice (MJ), the cause of obturation was a tumor of the periampullary zone. The patients are divided into two groups. The first group consisted of 51 patients, the second group included 54 patients. All patients of the main group underwent percutaneous perhepatic cholangiostomy for the purpose of decompression; bile sorption was performed using the domestic Lignov enterosorbent. The level of IL-6 in blood serum and bile was determined by enzyme immunoassay.

RESULTS. The use of bile sorption in the treatment complex significantly changed the concentration of IL-6 in blood serum (P<0.01) and bile. Determination of IL-6 in blood and bile makes it possible to more objectively assess the degree of cytokine-induced endogenous intoxication in response to ongoing therapeutic measures for tumors of the periampullary zone complicated by mechanical jaundice. The use of bile sorption contributes to a decrease in the concentration of the pro-inflammatory cytokine IL-6 in the blood and bile as an inducer of endogenous intoxication and a cascade of inflammatory processes in patients with tumors of the periampullary zone complicated by mechanical jaundice.

CONCLUSION. Bile sorption application helps to decrease proinflammatory cytokine IL-6 concentration in blood and bile as an inductor of endogenous intoxication and inflammatory processes cascade.

INTRODUCTION. In the Russian Federation, among all malignant diseases in the male population, gastric cancer ranks the 4^th, in women – 5^th place, and in terms of mortality in both sexes from malignant diseases – 2^nd place. During surgical treatment  of  patients  with gastric cancer, anemia is detected in more than ¹/4 of  patients, who significantly worsens the prognosis due to postoperative complications. Timely correction of anemia can reduce the risk of complications during surgical treatment and improve the course of the postoperative period.

OBJECTIVE is to evaluate the effectiveness of correction of anemia in the preoperative period and the results of radical surgical treatment in patients with gastric cancer

METHODS AND MATERIALS. The article presents the analysis of medical records of 30 patients aged 56–75 years with a diagnosis of gastric cancer complicated by anemia (hemoglobin level < 80 g/l). All patients in the preoperative period for the correction of anemia were prescribed iron (III) hydroxide oligoisomaltose intravenously at the dose of 20 mg/kg 21 days before surgery, due to the detection of iron deficiency in them.

RESULTS. The target blood hemoglobin level was more than 95 g/l. In the absence of the desired effect, erythrocyte transfusion was performed. The use of iron preparations made it possible to correct anemia in 14 (46.7 %) patients without resorting to transfusions, in 16 (53.3 %) patients, it was required to additionally transfuse 1 dose of erythrocytes, while earlier in the preoperative anemia was corrected using transfusions of 2–3 doses of erythrocytes. All patients underwent radical surgery with D2 lymph node dissection. Operations were accompanied by blood loss of 201.0±94.4 ml (120–475 ml). It was revealed that radical surgeries for gastric cancer in patients who received anemia correction in the preoperative period are accompanied by a low number of purulent-inflammatory (in 27.3 % of patients) and cardiovascular complications (in 20 % of patients).

CONCLUSION. Correction of anemia is a mandatory part of therapy in the preoperative period and allows to perform a full range of radical surgical intervention, improve the safety of surgical treatment and improve the course of the postoperative period. 

The leading role among causes of CVA (cerebrovascular accident) is occupied by pathology of the internal carotid artery. The most common etiological factor is a pronounced atherosclerotic process in the area of carotid artery bifurcation. Significantly less common factors are non-atherosclerotic causes of internal carotid artery disease, which include aneurysm and pathological tortuosity. Their combination significantly increases the risk of cerebral events, which requires timely surgical treatment. Surgical treatment is associated with certain intraoperative difficulties. The following is a clinical case of surgical treatment of an aneurysm of the internal carotid artery extracranial segment in combination with its deformation correlated with hemodynamic stenosis of more than 70%. A resection of the tortuosity-aneurysm complex with the formation of an end-to-end anastomosis of the internal carotid artery was performed.

Concomitant cardiovascular diseases in elderly patients with a hip fracture significantly increase the risk of developing postoperative complications. Developing the treatment algorithm for a combination of two or more diseases in this category of patients is the main task. The advantages of simultaneous surgery are one-stage repair of two or more surgical diseases, the implementation of one anesthetic procedure, the reduction in the total time of the patient’s stay in the hospital and the reduction in rehabilitation time. This paper presents the clinical observation of simultaneous surgical treatment of severe aortic stenosis and femoral neck fracture in an elderly patient.

The article presents a clinical case of treatment of patient K, 61 years old, with previously performed aorto-femoral bifurcation bypass surgery for critical lower limb ischemia. 6 months after the initial surgery, the patient developed thrombosis of the right arm of the prosthesis. After another 3 months, a persistent subfebrile body temperature appeared, multiple fistula passages formed with the release of pus in the areas of postoperative scars on the hips. Infection of a synthetic prosthesis was diagnosed. A decision was made to perform repeated surgical intervention in the volume of abdominal aortic reprosthetics with a cadaveric allograft. The surgery was performed at the clinic of the Faculty of Surgery of SamSMU: removal of the bifurcation synthetic prosthesis; rehabilitation of the prosthesis bed; reprosthetics of the aorta with vascular aortic allograft; endarterectomy from the deep artery of the thigh on both sides; bifurcation aorto-femoral reprosthetics; femoral-popliteal bypass with allograft on the right. The postoperative period was uneventful. Healing of wounds on the hips by secondary tension due to marginal skin necrosis. Critical limb ischemia was stopped. The patient was discharged on the 20th day in a satisfactory condition.

CONCLUSION. The use of allografts makes it possible to perform reprosthetics of the abdominal aorta in case of infection of synthetic prosthesis and simultaneous reconstruction of the femoral-popliteal segment.

In April, 2018, a 57-year old patient with cirrhosis of the liver (Child-Turcotte-Pugh B class) during the outcome of viral hepatitis B and C was performed Transjugular Intrahepatic Portosystemic Shunt (TIPS); and in June, 2018 – liver transplantation (LТ) from a deceased donor by Piggyback technique. In the postoperative period, abscesses in the left and right lobes of the liver and thrombosis of the hepatic artery thrombosis (HAT) were noticed. Balloon dilatations of biliary stricture with changes of biliary drainage were made during the period of 2 years. In May, 2022, according to the results of angiography, hepatic artery and its branches were seen up to segmental level that meant natural revascularization. Considering the low efficiency of the balloon plastic procedures carried out, there was formed trihepaticojejunostomy on the loop of the small intestine disconnected according to Roux-en-Y. The follow-up period is one and a half years; there are no signs of cholangitis and biliary hypertension.

There is no unified scheme of treatment for vascular and biliary complications in the clinics engaged in LТ, because every technique has both advantages and disadvantages. The idea of choice between intervention revascularization, transplantation and surgical reconstruction in the treatment of arterial thrombosis still remains incompletely understood.

Hernia of the xiphoid process refers to rare variants of hernial protrusion. For the period from 1914 to the present, only 11 cases have been described in the official Russian-language literature. Hernial gates are either a defect of a rounded shape directly in the xiphoid process, or splitting of the xiphoid process by the type of «horns». The contents are most often preperitoneal lipoma, and 2 cases have also been described when the contents were a strand of the large omentum and a fatty appendage of the transverse colon. The risk of infringement with such hernias is minimal. Operational tactics, despite the development of modern minimally invasive techniques, still remains controversial due to the peculiarities of the fit to the xiphoid process of the peritoneum and the thoracic own fascia to the periosteum of the sternum process. This paper presents a clinical case of a patient sought medical help for an increase in education in the xiphoid process within 4 months.

INTRODUCTION. The article describes the analysis of the Russian experience in the treatment of Amyand’s and De Garengeot’s hernias and the author’s observation of an extremely rare case of appendix incarceration in the right femoral hernia. The hybrid surgery was performed – open herniotomy for appendectomy of the distal part of the appendix and the laparoscopy to remove the remaining intraabdominal part of the appendix.

The OBJECTIVE was to describe the treatment tactics for the Amyand’s and Garengeot’s hernias based on the analysis of data from the Russian literature and our own clinical experience.

METHODS AND MATERIALS – review of the Russian literature and own clinical case.

RESULTS. 22 cases of Amyand’s hernia and only one of Garengeot’s hernia cases in 14 articles was found. CONCLUSION. The terms «Amyand’s hernia» and “Garengeot’s hernia” mean the development of acute appendicitis in cases of the location of the appendix in the hernial sac in inguinal or femoral hernias, respectively, and are also valid in cases of incarceration of these hernias, the contents of which are a secondarily modified as a result of incarceration of the appendix. Urgent surgical interventions for Amyand’s and De Garengeot’s hernias could be performed by traditional, laparoscopic and hybrid methods, depending on the preoperative diagnosis and intraoperative features.

A literature review of studies on the use of local negative pressure technique (vacuum therapy) in abdominal surgery is presented. The article highlights modern approaches to its use in emergency pathology of the abdominal cavity and retroperitoneal space. The mechanisms of action, advantages and disadvantages of the local negative pressure technique, as well as the main morphofunctional aspects of its application are discussed in detail. Data from recent clinical studies and meta-analyses are summarized, and the effectiveness of using vacuum-assisted laparostomy within the framework of the «damage control» concept in multi-stage surgical treatment of injuries and urgent abdominal diseases accompanied by abdominal sepsis is demonstrated. The use of local negative pressure techniques can reduce postoperative mortality, as well as shorten the length of hospital treatment of patients. However, despite the obvious positive effect on the course of the wound process, vacuum therapy carries the risk of developing serious complications, the most dangerous of which are bleeding and perforation of hollow organs. In addition, it requires very expensive equipment and consumables, as well as training of medical personnel. Thus, the use of vacuum therapy requires a sound approach and a clear understanding of the technical features of its implementation. However, the indications for the use of local negative pressure in abdominal surgery have not yet been clarified, which undoubtedly hinders the wider introduction of this promising technique into clinical practice.