An outstanding surgeon, scientist and teacher, one of the pioneers of thoracic surgery in Russia, the creator of a major scientific school of surgeons and anatomists, the founder (together with N. V. Sklifosovsky) and editor of the first surgical journal in Moscow (“Surgical Chronicle”), a public figure in the field of healthcare, Professor Petr Ivanov ich Diakonov was born in Orel on June 2 (14, new style), 1855, into the family of lawyer Ivan Vasilevich Diakonov. In 1870, Petr graduated from 7 classes of the Oryol boys’ gymnasium and in 1871 entered the Imperial Medical and Surgical Academy. In the 4th and 5th years, he was arrested twice and imprisoned for active participation in the revolutionary democratic movement, and shortly before completing his studies, he was sent into exile to Veliky Ustyug. In 1877, he was mobilized into the army and participated in the Russo-Turkish War. In 1878, he received permission to complete his studies at the Medical and Surgical Academy and in May 1879 received a doctor’s diploma. He worked as a zemstvo doctor in the Oryol province, then as a resident doctor at the provincial hospital. In 1887, Professor A. A. Bobrov invited Petr Ivanovich to the position of assistant to the prosector of the Department of Operative Surgery and Topographic Anatomy at Moscow University. In 1888, P. I. Diakonov defended his doctoral dissertation «Statistics of blindness and some data on the etiology of blindness among the Russian population». In 1893, he was elected head of the Department of Operative Surgery and Topographic Anatomy, and in 1901, he headed the Department and Clinic of Hospital Surgery at Moscow University and in 1903 received the title of ordinary professor. Scientific and practical works published under the supervision of P. I. Diakonov and characterizing his school cover many sections of surgery. The topics devoted to the study and treatment of external abdominal hernias, surgical treatment of cholelithiasis, ma lignant neoplasms of various localizations, diseases of the esophagus, hemorrhoids, bone and joint tuberculosis, issues of plastic surgery and pediatric surgery were developed in particular detail. P. I. Diakonov was the author and co-author of 67 scientific and practical works, including such fundamental works as the manual «Russian Surgery», «General Operative Surgery», «Diseases of the Neck», «Restoration of a Destroyed Nose», «A Brief Guide to the Preparation of Preparations on Topographic Anatomy», «Lectures on Topographic Anatomy and Operative Surgery». Among Petr Ivanovich’s students, 23 defended their doctoral dissertations. Professor P. I. Diakonov died on December 21, 1908 (old style) at the age of 53 in Moscow and was buried at the Vagankovskoe Cemetery.

INTRODUCTION. Resections of tracheal bifurcation is a very complex surgery, associated with a very high probability of adverse events in the postoperative period from the tracheobronchial anastomosis.

The OBJECTIVE was to demonstrate the technical aspects of pneumonectomy with resection of tracheal bifurcation, to evaluate various options for covering tracheobronchial anastomosis.

METHODS AND MATERIALS. The cases of 57 patients who underwent resection of tracheal bifurcation were analyzed. In 42 (74 %) cases, such intervention entailed removal of the right lung. In 15 (26 %) cases, left pneumonectomy was performed. All patients were operated on for malignant lung neoplasm.

RESULTS. The effectiveness of using both mediastinal (pericardial flap, adipose flap) and muscular flaps (intercostal muscle, latissimus dorsi muscle), used both to seal the anastomosis and to separate the anastomosis from adjacent vital structures, was revealed. Mediastinal flaps are preferable in terms of minimizing the total time of the operation and reducing trauma to the patient.

CONCLUSION. The use of the presented algorithm for choosing an autoplastic flap allows for the effective use of vari ous options for protecting the bronchial suture line.

The OBJECTIVE was to perform the survival analysis of patients after pneumonectomy.

METHODS AND MATERIALS. The retrospective study included 93 patients with non-small cell lung cancer (NSCLC) who underwent pneumonectomy from 2014 to 2024.

RESULTS. The average age of the patients who underwent surgery was 61 years. Squamous cell carcinoma was diag nosed in 50.5% of patients, adenocarcinoma – in 32.3 % of patients, other histological types – in 17.2 % of patients. 6 (6.4 %) patients died in the early postoperative period, of which 5 had right pneumonectomy. The overall 3- and 5-year survival rates were 50.57 % and 34.38 %, respectively, disease-free survival rate – 43.68 % and 32.18 %, respectively.

CONCLUSIONS. In the structure of long-term outcomes in 40% of patients who underwent pneumonectomy, the cause of death was non-oncological pathology, most of the causes of non-oncological mortality were directly related to pneumonectomy.

The OBJECTIVE was to determine the indications and timing of wound drainage in patients with postoperative ventral hernias using mesh prostheses.

METHODS AND MATERIALS. A retrospective analysis of 137 patients underwent elective prosthetic mesh hernioplasty for postoperative ventral hernias during 2020 – 2023 was carried out. Patients were divided into 2 groups: 55 patients without wound drainage (group 1) and 82 patients who had vacuum-aspiration drainage of the wound (group 2).

RESULTS. In group 1, W3 hernias were diagnosed in 15 (27 %) patients, with significantly higher frequency in group 2 – 44 (54 %) patients (p=0.002). In group 1, simultaneous operations were performed in 10 (18 %) patients, and 46 (56 %) patients underwent simultaneous operations in group 2 (p<0.001). Rives-Stoppa hernioplasty was performed in all patients of group 1. In group 2, 62 (76 %) patients underwent hernioplasty using Rives-Stoppa method, 15 (18 %) patients had corrective hernioplasty, and in 5 (6 %) patients, posterior separation hernioplasty was done. Both groups had significant difference in used methods of hernioplasty (p=0.013). In group 1, 30x30 cm prostheses were used in 23 (42 %) patients; in group 2, the same size mesh was used in 52 (64 %) patients (p=0.027). Both groups did not differ significantly in frequency of wound complications (p=0.527). The term of drainage removal did not exceed 9 days in patients of group 2 with uncomplicated wound healing. The average postoperative in-hospital stay in group 1 was 7.6±0.3 days versus 13.3±1.2 days in group 2 (p<0.001).

CONCLUSION. Indications for drainage of postoperative wound in patients with POVH are: the width of hernial defect of 10 cm or more, implantation of large mesh, using of separation methods of hernioplasty, as well as simultaneous operations. The period of wound drainage should not exceed 9 days.

OBJECTIVE. Despite the various of methods for obliterating the pleural cavity, it is impossible to ensure absolute prevention of recurrent spontaneous pneumothorax (SP). Deciding the treatment strategy for SP after previous anti recurrent treatment, surgeons rely on their own experience and capabilities rather than on objectively proven principles.

METHODS AND MATERIALS. We analyzed the treatment results of 24 patients with episodes of SP who had previ ously undergone anti-recurrent treatment in the form of pleurodesis induction.

RESULTS. In 14 patients (0.58), pneumothorax was classified as primary, while in 10 patients (0.42) – as secondary. The causes of secondary SP included pulmonary emphysema (2 patients, 0.08), lymphangioleiomyomatosis (4 patients, 0.16), and endometriosis-associated SP (4 patients, 0.16). Primary pleurodesis induction was performed via thoracoscopic pleurectomy in 8 patients (0.33), thoracotomy with pleurectomy – in 4 patients (0.16), and sclerosing agent administration through the pleural drainage - in 12 patients (0.50). For the treatment of recurrence after primary pleurodesis induc tion, the following methods were used: subtotal pleurectomy via thoracotomy (6), thoracoscopy (8), and sternotomy (1) in 15 patients (0.63); thoracoscopy with powder talc insufflation in 3 patients (0.13); and talc suspension administration through drainage in 2 patients (0.08). Additionally, in 4 patients (0.16), no invasive procedures were performed due to the small volume of pneumothorax. No clinically significant recurrences were noted during subsequent follow-up.

CONCLUSION. The choice of treatment for recurrent SP after pleurodesis induction should be individual – from subtotal pleurectomy by thoracotomy or thoracoscopy to drainage and spraying of sclerosant or even simple observation, which depends on the state of the lung parenchyma, the volume and localization of air accumulation in the pleural cavity. Such treatment must be carried out in specialized thoracic departments only.

INTRODUCTION. Currarino – Silverman syndrome is a very rare deformity of the sternum and chest wall resulting from premature obliteration of the manubriosternal joint. In this paper, we present the experience of radical thoracoplasty using osseous osteosynthesis in patients with Currarino – Silverman syndrome.

METHODS AND MATERIALS. Surgical treatment includes bilateral subcostal resection of rib cartilage, osteotomy of the sternum and its correction in the correct anatomical position using intraosseous and osseous osteosynthesis.

RESULTS. The study included 4 patients (1 men and 3 women) aged from 22 to 30 years. The average surgery time was 146±17 minutes. Patients were activated on the 2nd day and discharged on the 7th day after surgery. The observation period after correction ranged from 6 months to 3 years. No complications or relapses were recorded. All patients are satisfied with the results of the correction.

CONCLUSIONS. Radical thoracoplasty using osseous osteosynthesis for chest deformity in patients with Currarino – Sil verman syndrome allows achieving an optimal correction result with minimal postoperative scarring and high satisfaction.

The OBJECTIVE was to substantiate the algorithm for selecting and implementing surgical tactics for gunshot peritonitis (GP) taking into account the characteristics of its clinical course.

METHODS AND MATERIALS. The results of treatment of 472 victims with gunshot wounds to the abdomen were analyzed. As part of the tactics of multi-stage surgical treatment, modern techniques were used: vacuum-assisted and vacuum-instillation laparostomy (VAL and VIL), while the choice of indications was carried out using the peritonitis progression risk scale developed in the clinic.

RESULTS. The frequency of postoperative complications was 43.8 %, and hospital mortality was 4.9 %. At the same time, in 45 % of cases, the trigger factors for thanatogenesis were complications associated with defects in surgical treatment at previous stages. The progression of peritonitis with the development of abdominal sepsis against the background of the treatment carried out in the clinic was noted only in 8 % of cases. The incidence of unformed intestinal fistulas was 9.8 %, and with VIL this figure was significantly lower than with VAL: 2.4 % versus 12.1 % (p=0.06). In addition, the use of VIL was accompanied by a more rapid elimination of pathogenic microflora and a less pronounced adhesive process.

CONCLUSION. The relief of GP requires multi-stage surgical treatment. The key to its successful implementation is compliance with uniform tactical approaches, as well as the use of an effective technique for temporary closure of the abdominal cavity. The original scale of the risk of peritonitis progression provides a reasonable approach to laparostomy, with VIL being the most preferable option.

An observation from practice is presented – a case of treatment of a pancreatic pseudocyst complicated by a break through into the posterior mediastinum. The article demonstrates the difficulties of diagnosis and surgical treatment of patients with complicated pancreatic pseudocysts.

In the treatment of severely burned patients, the most effective prevention of infectious complications is early necrectomy. Currently, according to the clinical recommendations of the All-Russian public Organization “Association of Combustiolo gists “The World without Burns”, the maximum volume of necrectomy in one stage is ¹/₃ of the surface of deep burn wounds of the patient. In this clinical case, we provide an example of successful treatment of a patient using early combined necrectomy (exarticulation of the lower extremities at the knee joint level and necrectomy in a single block to the fascia in the hip area on an area of 10 % of the body surface) of ¹/₂ of the surface of deep burn wounds (28 % of the body surface) on the 5th day after injury.

The OBJECTIVE was to demonstrate the result of surgical treatment of a victim with an occupational trauma, which included an open comminuted fracture of the bones of the left forearm with partial skin loss and skin undermining from the hand to the upper third of the shoulder. The patient suffered a high-energy occupational trauma as a result of the left upper extremity getting into a machine tool. At the prehospital stage, the ambulance team applied a tourni quet on the upper third of the shoulder and aseptic dressing. When the patient was admitted to the shock room, the patient was examined by the multidisciplinary team. The left upper extremity was assessed by visual examination and additional study methods (radiography, soft tissue ultrasound and ultrasonic dopplerography of vessels). Based on the results of the examination and studies, the decision was made to carry out treatment in several stages.

The article presents information highlighting some moments of the evolution of surgical instruments used to perform skull trepanation from ancient times up to the Modern Age (late 19th century), when the period of skull surgery ended and a new surgical specialty, neurosurgery, emerged. Almost all of these instruments went out of use with the develop ment of microsurgery, but the study of the history of medicine and understanding of the stages of its development is one of the fundamental bases in the formation of the worldview of any competent modern doctor.

Aortic arch surgery is one of the most challenging field of cardiovascular surgery. Reconstructive interventions on the aortic arch are associated with high risks due to the peculiarities of anatomy and technical complexity of surgical intervention. Antegrade cerebral perfusion in combination with hypothermia is widely used to protect the brain during aortic arch surgery. Antegrade cerebral perfusion can be performed in unilateral or bilateral way. Now, there is no clear guidelines regarding the management of patients operated on the aortic arch. This review highlights the main methods of protecting the brain during aortic arch surgery and shows the results of the studies comparing antegrade unilateral brain perfusion with bilateral one. We reviewed rationale of various researchers in choosing two proposed methods to reduce the risk of neurological complications.