Professor Lev Valeryevich Lebedev worked at the Department of Faculty Surgery of the Pavlov University for 34 years, including 17 years as the head of the Department. On the occasion of the 100th anniversary of the birth of the surgeon, teacher and organizer of the angiosurgical service in St. Petersburg, we publish materials dedicated to the life of L. V. Lebedev, the scientific directions that he developed in Leningrad-St. Petersburg and in the 1st LMI – Pavlov University.

The OBJECTIVE was to identify significant risk factors of complications after carotid endarterectomy in the acute period of ischemic stroke, thus improving the outcomes of surgical treatment of symptomatic internal carotid artery stenosis.

METHODS AND MATERIALS. The results of treatment of 776 patients after carotid endarterectomy in the acute period of stroke operated in the State Budgetary Institution of Tuberculosis «Regional Clinical Hospital № 2» were subjected to the factor analysis. catamnesis of the disease was traced for at least one year from the surgical intervention.

RESULTS. Repeated ispilatory stroke occurred in 13 patients. Significant factors were tortuosity of the target artery (OR, 6.94; 95 % cI=2.21–21.86; p=0.003), aneurysm in the tortuosity zone (OR, 138.5; 95 % cI=11.6–1643.1; p=0.001), the presence of an electric cardiac pacemaker in the patient (OR, 31.71; 95 % cI=2.69–373.84; p=0.05), and need for IcA resection (OR, 6.83; 95 % cI=2.1–21.48; p=0.004). The risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt (OR – 35.86; 95 % cI=2.17–592.92; p=0.05). Tortuosity of the target artery (OR – 4.6; 95 % cI=1.1–18.3; p=0.017), the need for IcA resection and in the presence of complicated atherosclerotic plaque in the reconstruction area (OR – 6.84; 95 % cI=1.89–24.85; p=0.01) turned out to be the sig nificant risk of death in the immediate postoperative period.

CONCLUSIONS. Significant risk factors for recurrent stroke and death after carotid endarterectomy performed in the acute period of stroke were the tortuosity of the target artery, an aneurysm in the tortuosity zone, the presence of an electric cardiac pacemaker in the patient and the need for IcA resection in the presence of complicated atherosclerotic plaque in the reconstruction zone. The only risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt. Further large trials are needed to clarify the obtained results.

The OBJECTIVE was to determine the efficacy of endovascular surgery for in-hospital acute ischemic stroke (AIS) and to identify predictors of unfavorable AIS outcome.

METHODS AND MATERIALS. We performed 42 endovascular thrombectomies for in-hospital AIS in patients treated in the hospital for another pathology. Neurological defiCIT was determined by NIHSS scale, thrombectomy efficacy was evaluated by the degree of cerebral revascularization by mTICI scale, functional outcome was determined by Rankin scale (mRS). Multivariate analysis with evaluation of clinical and laboratory, neuroimaging data, and analysis of surgical technique was performed to identify factors contributing to adverse stroke outcome.

RESULTS. The mean age of patients was 73.8±11.8 years old. Neurological defiCIT before surgery was 12.8±6.7 points by to NIHSS. Thrombolytic therapy was used in one third of cases, thrombectomy in 92.9 %, and carotid artery stent ing in 2 cases. Successful revascularization (mTICI2b-3) was achieved in 83.3 % of cases. The significant reduction in neurological defiCIT after surgery was achieved to NIHSS 6.0±5.9 points, mRS 2.7±2.1. The mortality rate amounted to 16.7 % of cases. Poor functional outcome (mRS3-5) was significantly associated with: female gender, older age, presence of cardiovascular pathology, recurrent stroke, postoperative tachycardia, low renal tubular filtration rate, hypocoagulation, low cardiac ejection fraction, low aortic valve opening amplitude, high pulmonary hypertension, large left atrial volume, initial severe neurological defiCIT, poor collaterals in the area of cerebral ischemia, proximal internal carotid artery occlusion, hemorrhagic saturation, increased operation time, low degree of revascularization (mTICI0-2a).

CONCLUSION. Endovascular surgery has demonstrated its safety and high efficacy in the treatment of in-hospital AIS in surgical hospitalized patients. Endovascular thrombectomies allow to significantly reduce neurological defiCIT and decrease mortality in the severe category of patients with cardioembolic AIS. clinical, laboratory, hemodynamic and neuroimaging factors influencing on poor functional outcome of in-hospital AIS have been determined.

THE OBJECTIVE was to analyze the development of chronic pain syndrome after performing standardized Lichtenstein hernioplasty.

METHODS AND MATERIALS. The prospective single-center study was conducted with 40 patients with inguinal hernias (20 patients in the study group and 20 patients in the control group) who underwent Lichtenstein hernioplasty with adherence to standardization criteria and without. The comparative analysis of the early and long-term postoperative periods was performed.

RESULTS. When comparing the early and long-term postoperative periods in patients after standardized Lichtenstein hernioplasty, the following data were obtained: pain syndrome according to the Visual Analogue Scale (VAS) was less pronounced after applying standardization criteria (p < 0.001), and statistically significantly lower number of complications (seroma, paresthesia) developed (p=0.045, p=0.019). In the group of patients who underwent standardized Lichtenstein hernioplasty, chronic pain syndrome was not observed in the long-term postoperative period (p < 0.001).

CONCLUSIONS. Prevention of chronic postoperative pain syndrome after hernioplasty using the Lichtenstein method is the significant issue. This article emphasizes the importance of considering various factors and implementing preventive strategies to minimize the risk of this complication and ensure optimal surgical outcomes.

BACKGROUND. Intraand postoperative colonic bleeding is the most frequent complication in endoscopic removal of large colonic polyps. In this article, one of the methods of preventing this complication is discussed – preliminary preventive ligation of the leg of the polyp, carried out by using an endoscopic loop ligation.

METHODS AND MATERIALS. The prospective trial provided between March and September 2023. This trial included 38 patients with 39 colonic polyps with the feeding leg of the polyp non-less than 5 mm in diameter. All patients underwent endoscopic mucosal resection within the leg of the polyp with preliminary preventive ligation of the leg. The ligation provided by the device inserted through the instrumental channel of the endoscope, and allowing delivery and tightening of the non-dissolving Rцder’s loop on the leg of the polyp.

RESULTS. All identified polyps were successfully removed. The radicality of the removal was confirmed by histological examination data. The occurrence of technical difficulties during removal was noted in one case when removing the polyp 4 cm in diameter. The appeared technical difficulties were associated with difficult visualization of the feeding leg of the polyp, which was due to the large size of the removed formation. Positive correlation between the forma tion size and surgery time was observed (Spearman p=0.52, P=0.034). There were no bleeding complications during operations and early postoperative period.

CONCLUSION. Preliminary preventive ligation is a simple, effective and safe method to prevent bleeding when remov ing polyps of the mucous membranes of the gastrointestinal tract.

The OBJECTIVE was to evaluate the results of surgical treatment of abdominal aortic aneurysm using laparotomic and retroperitoneal approaches.

METHODS AND MATERIALS. The study included 206 patients operated on at the Department of Vascular Surgery of the Novgorod Regional Clinical Hospital from 2010 to 2018. All patients were divided into 2 groups. The first – 112 people, whose surgical intervention was performed through laparotomic approach. The second – 94 patients, approach to the aorta was made by the retroperitoneal technique according to Rob. comparison of non-specific life-threatening complications included the development of myocardial infarction and acute cardiovascular failure, acute respiratory distress syndrome and respiratory failure, the development of ischemic colitis and small bowel obstruction, which required repeated interventions. The development of acute renal injury was characterized as an increase in creatinine by 50 % from baseline or a decrease in glomerular filtration rate (GFR) by more than 25 %. This group of complications also included ischemic stroke, sepsis, and multiple organ failure. Wound complications included insolvency of postoperative wounds of retroperitoneal and laparotomic approaches, cases of eventration.

RESULTS. When analyzing the incidence of nonspecific complications, it was found that in group I their frequency was 41 (46.6 %) clinical cases, and in group II – 26 (27.6 %) (p=0.173*). In group I, the incidence of cardiovascular complications significantly exceeded those in group II – 17 (15.2 %) vs 6 (6.4 %) (p*=0.046). The incidence of gastrointestinal complications was also significantly higher in group I – 9 (8 %) vs 1 (1.06 %) (p*=0.021). The frequency of deaths in groups I and II did not differ significantly in 7 (6.25 %) and 5 (5.3 %) cases (p*=0.77).

CONCLUSION. As our study showed, retroperitoneal approach is a worthy alternative to laparotomy, mainly in case of repeated interventions, as well as in the presence of signs of visceral obesity of the patient. At the same time, laparotomic approach is associated with a higher risk of developing cardiovascular and gastrointestinal complications in the treatment of abdominal aortic aneurysms.

The OBJECTIVE was to study the possibilities of endoscopy in the diagnosis and treatment of bleedings in patients with pancreatitis.

METHODS AND MATERIALS. Based on the analysis of 135 patients with pancreatitis complicated by gastroduodenal bleeding, we determined the location and possibilities of endoscopic hemostasis. The article analyzes 2 groups of patients. The first group (64 patients with acute pancreatitis and gastroduodenal bleeding). The second group (71 patients with chronic pancreatitis complicated by gastroduodenal bleeding). The article shows features of endoscopic examination of patients with pancreatitis complicated by gastroduodenal bleeding.

RESULTS. The leading method of stopping bleeding in these groups of patients is endoscopic hemostasis.

CONCLUSION. The choice of endoscopic hemostasis method depends on the cause and nature of the bleeding. The developed technique of endoscopic hemostasis has reduced the mortality rate from gastroduodenal bleeding in patients with pancreatitis to 3 %.

The trend towards minimally invasive and excellent cosmetic effect has affected the most difficult section of cardiac surgery – the aortic root. To date, there are various minimally invasive approach for the correction of aortic root pathol ogy, which are used in single clinics in the world. The objective of this literature review was to study the current state of minimally invasive aortic root surgery and critically evaluate methods of correcting its pathology from different types of minimally invasive approach. The minimally invasive approach to these operations is presented in this review of the literature. A mutual comparison of minimally invasive approaches was carried out, their advantages over the traditional approach were determined. Despite the attractiveness of the technique, there are serious limitations of its wide appli cation, such as a long learning curve, an extremely low number of long-term results and the absence of multicenter, randomized comparison studies with traditional approach.

INTRODUCTION. Lipomas are benign mesenchymal tumors consisting of mature adipocytes. They are classified according to their histological picture, localization in the oral cavity and the type of tissues involved in the pathological process.

The OBJECTIVE was to present the clinical case and literature review.

MATERIALS AND METHODS. We conducted the search in the PubMed database for the last 86 years (1937–2023) with keywords «oral lipoma» or «tongue lipoma».

RESULTS. We reviewed 60 articles with 77 identified lipomas. The most publications were represented by the USA (n=10, 16.39%) and India (n=10, 16.39%). We found out that the average age was 51.38 years (51.38±15.57); and most of them occurred over 50 years old. Lipomas are mainly localized on the mucous membrane of the cheek (n=24, 31.17%), then on the tongue (n=17, 22.8%) and in other places. The most common histological picture was spindle cell lipomas (n=13, 27.66%), followed by fibrolipomas (n=8, 17.02%) and other types.

CONCLUSIONS. Lipomas are relatively rare neoplasms of the oral cavity. chronic traumatization of the oral mucosa is the predisposing factor for lipoma development. Preventive examinations every six months is recommended, if a patient has dental constructions. Any formation removed from the oral cavity is subjected to histological verification.

The development of systemic antitumor treatment, targeted therapy and immune checkpoint inhibitor therapy (ICI) has changed the treatment outcome and prognosis for locally advanced non-small cell lung cancer (NSCLC). Modern recommendations provide for the division of such patients into potentially resectable and unresectable, and such division does not always correspond to stage IIIa, IIIb or IIIc of the disease. The treatment of resectable tumors is recommended to start with neoadjuvant chemoimmunotherapy (CIT), followed by surgical intervention aimed at radical tumor removal only in patients who respond to treatment. For unresectable tumors, the best approach is considered to be simultaneous chemoradiation therapy (CRT) followed by adjuvant ICI therapy, and the role of surgical interventions is limited to salvage surgery – residual tumor or local relapse removal after non-surgical self-treatment.

This approach to the treatment of patients with stage III NSCLC is unlikely to fully satisfy specialists and patients – there is no complete consensus on the definition of the term «resectability»; the possibility of converting an unresect able tumor into a resectable one as a result of neoadjuvant treatment is denied, which is contrary to clinical practice. The objective of the article was the critical analysis of existing recommendations on the role of the surgical approach as a stage of complex treatment of stage III NSCLC from the surgeon’s point of view.

Outstanding Soviet surgeon, scientist, teacher, health care organizer and public figure, founder of the largest scien tific and practical school of surgeons, Minister of Health of the USSR (1965–1980), Hero of Socialist Labor (1968), academician of the USSR Academy of Medical Sciences (1966) and the USSR Academy of Medical Sciences (1957) (RAS and RAMS since 1991), laureate of the Lenin Prize (1960) and the State Prize of the USSR (1971), Honored Scientist of the RSFSR (1957), Professor Boris Vasilyevich Petrovsky was born on June 14 (27 according to the new style), 1908 in the CITy of Essentuki in the family of a doctor. In 1926, he entered the medical faculty of Moscow State University, in 1930, he received a medical diploma and worked as a surgeon in a regional hospital in the Moscow region, and in 1932, he was appointed to the position of the researcher at the Moscow Oncology Institute under the leadership of Professor P.A. Herzen. During the Soviet-Finnish and the Great Patriotic Wars, he served as a surgeon in various hospitals. In 1947, he defended his doctoral dissertation «Surgical treatment of gunshot wounds of blood vessels at the front line». In 1951, B. V. Petrovsky was elected the head of the department of faculty surgery of the pediatric faculty of the 2nd MMI named after N. I. Pirogov, and in 1956 – the head of the department of hospital surgery of the 1st MMI named after I. M. Sechenov. In 1963, the All-Union Scientific center for Surgery of the USSR Academy of Medical Sciences was created in Moscow, the organizer and director of which (1963–1988) was Boris Vasilievich (since 1989 – honorary director of the All-Union Scientific center for Surgery). At the same time, from 1965 to 1980, he headed the USSR Ministry of Health. Academician B. V. Petrovsky created the largest scientific and practical surgical school in the history of our country, which included more than 150 doctors of medical sciences. He was the author and co-author of about 700 scientific papers, including 45 monographs and manuals devoted to vari ous problems of cardiovascular, thoracic, abdominal, and military field surgery. Boris Vasilievich was the member of 34 international societies, associations, academies and colleges, as well as the honorary member of 14 foreign surgical societies. Academician B. V. Petrovsky died on May 4, 2004 and was buried at the Novodevichy cemetery in Moscow.

Ischemic heart disease is a common disease among the population. Due to the high mortality rate related to this disease, improving its treatment has always been a focal point. cardiologists, along with surgeons, have conducted multidirectional scientific researches for a long time to improve the treatment of acute coronary syndrome. Finally, in 1957, V. P. Demikhov’s experiments on dogs laid the foundation of the treatment of acute coronary syndromes.

Taking advantage of this experience, in 1964, V. I. Kolesov managed to restore the impaired blood supply by connect ing the internal mammary artery to the lower part of the coronary artery from the blocked part of the coronary artery in a patient with acute coronary syndrome.

This treatment method, which the author called mammary-coronary anastomosis, soon attracted the attention of a number of surgeons around the world who tried to restore the impaired blood supply to the myocardium using this method.

The article provides information about researches conducted by distinguished scholars who have made significant contributions to the development of mammary-coronary anastomosis. Also, it offers more detailed information about the role of the renowned surgeon V. I. Kolesov and his school in the development of this treatment method.

The refinement of the technique for performing mammary-coronary anastomosis is attributed specifically to the school of V. I. Kolesov. Under his guidance, researches conducted by his students led to the development of the technique for placing mammary-coronary anastomosis using a vascular sewing machine. This also gave rise and justified the idea of performing coronary artery surgery on a beating heart.

The article also presents extensive information about a new myocardial infarction model that is suitable for demonstrat ing the dependence of myocardial blood supply restoration through mammary-coronary anastomosis on the duration of coronary artery occlusion. Even so, the article highlights the role of colleagues from the Department of Faculty Surgery № 1 at Pavlov First Saint Petersburg State Medical University in the creation and development of this method.