An outstanding reformer of medical education in Russia, a talented surgeon, scientist and teacher, the founder of domestic plastic and reconstructive surgery, Academician (1849) and president (1857–1867) of the Imperial Medical and Surgical Academy, head of the Main Military Medical Directorate (1867), corresponding member of the Paris Medical Academy (1846), privy councilor (1849), doctor of medicine and surgery (1837), Professor (1837) Pyotr Alexandrovich Dubovitsky was born in Moscow on February 18 (March 2, new style) in 1815 into a noble family of a landowner in the Ryazan province. Pyotr Dubovitsky received an excellent education at home and at the age of 14, he entered the medical faculty of Moscow University, which he successfully graduated from in 1833 and then went to Paris for an internship in surgery, where in 1835, he published a monograph in French on lithotripsy «An exact reproduction of the discussion on stone crushing and stone cutting that took place at the Royal Medical Academy in 1835». This work was recognized among specialists, and after returning to St. Petersburg in 1837, P. A. Dubovitsky defended a dissertation on this topic at the Imperial Medical and Surgical Academy and received the academic degree of Doctor of Medicine and Surgery at the age of 22. In the same year, he was appointed extraordinary Professor of the department of general and special surgery at Kazan University, and in March 1838, he was elected ordinary Professor. The greatest successes were achieved in the field of plastic and reconstructive surgery. In 1839 in Kazan, as a result of an accident, P. A. Dubovitsky received a serious injury – a complex intra-articular fracture of the left humerus, which resulted in the development of ankylosis of the left elbow joint. In 1841, Pyotr Alexandrovich was elected Professor of the department of theoretical surgery of the Imperial Medical and Surgical Academy. The curriculum was significantly expanded and improved, and the quality of teaching surgery at the department reached a fundamentally new level in a few years. From 1857 to 1867, P. A. Dubovitsky held the post of president of the Medical and Surgical Academy. During this time, the number of departments in natural and medical sciences was doubled. Independent departments were created: chemistry, physics with climatology, botany with phytotherapy, zoology with comparative anatomy. For the first time in Russia and Europe, departments of pathological anatomy, operative surgery and topographic anatomy, hygiene and medical police, childhood diseases, mental and nervous diseases were created, and the department of eye diseases was restored. On the initiative of P. A. Dubovitsky in 1858, the «Medical Institute» was established at the Medical and Surgical Academy to train scientific and teaching staff, which became the prototype of adjunct and postgraduate studies. By decree of Pyotr Aleksandrovich, it was permitted to write and defend dissertations in Russian. In March 1867, the Medical Department of the War Ministry was reorganized into the Main Military Medical Directorate, headed by P. A. Dubovitsky. Professor P. A. Dubovitsky died on March 30, 1868 from a malignant disease and was buried in the Old Cemetery of the Donskoy Monastery in Moscow. Pyotr Aleksandrovich was the last president in the history of the Imperial Medical and Surgical Academy and the only person to whom, by decision of the IMHA Conference, a full-length monument was erected in the meeting room of the Academic Council. 

The increase in the number of patients with well-differentiated thyroid cancer with frequent detection of its radioiodine refractory forms requires preoperative diagnostics through the development and application of the most effective high-tech examination methods, the most promising of which are molecular genetic studies of puncture material. The results of examination and surgical treatment of 103 patients with well-differentiated thyroid cancer were analyzed, the preoperative examination of which was supplemented by determining the expression of the sodium iodide symporter and the BRAF V600E mutation. The limiting value of nIS was established, which allows predicting the development of cancer resistance to postoperative radioactive iodine therapy, as well as its relationship with the BRAF mutation in order to determine the need to expand the scope of surgical intervention.

The OBJECTIVE was to improve immediate and long-term outcomes of surgical treatment by optimizing the choice of treatment strategy for patients with squamous cell carcinoma of the thoracic esophagus cT2N0M0.

METHODS AND MATERIALS. The analysis included 57 patients who underwent surgery for squamous cell carcinoma of the thoracic esophagus cT2N0M0 at the P. Hertsen Moscow Oncology Research Institute from 2005 to 2023. The upfront surgery group comprised 67 % (n=38) of the patients. Combined treatment was implemented in 19 (33 %) of the 57 patients. The accuracy of clinical staging of the tumor process was assessed, and a statistical analysis of risk factors for poor prognosis was performed. Overall and recurrence-free survival rates were evaluated using the Kaplan–Meier method.

RESULTS. Subgroup statistical analysis revealed that tumors ≤4 cm in length (n=33) on endoscopy were a prognostically favorable group, regardless of the presence or absence of preoperative treatment, with all patients reaching the 5-year overall survival mark. In the group with tumors >4 cm (n=24), true pT2N0M0 was found in only 44 %, with understaging – in 56 % and overstaging – in 0 %. Analysis of long-term outcomes revealed a median overall survival of 28 months in the combined treatment group versus 26 months in the up-front surgery group (p=0.87). The 3-year overall survival was 31 % versus 40 % (p=0.977), and the 5-year overall survival was 16.6 % versus 40 % (p=0.684) respectively.

CONCLUSION. Based on the study, it can be concluded that tumor length ≤4 cm is a favorable prognostic factor, and upfront surgery is preferable for such patients. In the group with tumors >4 cm, no statistically significant difference in long-term outcomes was found between the combined treatment and up-front surgery groups. However, in most cases, understaging occurs in this group, and such tumors should be interpreted as locally advanced processes, for which multimodal therapy is recommended according to current clinical guidelines.

INTRODUCTION. Surgical intervention remains the only effective treatment for gastric cancer. Despite advances in surgical techniques, tissue dissection and coagulation methods, and the quality of postoperative intensive care, the incidence of early complications remains considerably high. One of the most serious postoperative complications is acute pancreatitis, which significantly prolongs hospital stay and may lead to unsatisfactory treatment outcomes.

The OBJECTIVE was to determine the incidence and risk factors for the development of acute pancreatitis following gastrectomy.

METHODS AND MATERIALS. From 01.01.2018 to 31.10.2023, a total of 198 patients with stage I–III gastric cancer underwent gastrectomy at the Ulyanovsk Regional Oncology Center (Database State Registration Certificate no. 2024622328). Statistically significant factors influencing the development of acute pancreatitis after gastrectomy were identified.

RESULTS. The incidence of acute pancreatitis (AP) was 8 % (16 out of 198). Among the 16 patients with AP, 5 developed a grade B external pancreatic fistula. Statistical analysis revealed a significant difference in the incidence of acute pancreatitis depending on the T category. Intraoperative blood loss volume also had a significant impact on the development of acute pancreatitis. Risk indicators for AP included the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (nLR). The threshold value for PLR was 215.6, and for nLR – 15.5. Exceeding these values predicted the development of AP in the postoperative period.

CONCLUSION. Significant risk factors for the development of AP are the tumor size and depth of invasion (T category) and intraoperative blood loss exceeding 500 ml. Elevated serum amylase, PLR, and nLR levels on the first postoperative day, in the absence of other inflammatory signs, should be considered potential indicators of AP. 

The OBJECTIVE was to study the clinical course of purulent wounds with topical application of ultrasound treatment.

METHODS and MATERIALS. The study involved 70 patients undergoing inpatient treatment in the department of purulent surgery in the period from 2023 to 2024. The study design was a prospective simple controlled randomized clinical trial in which two parallel patient groups were created. The main group consisted of 35 patients, where ultrasound debridement of wounds was used against the background of complex treatment, the comparison group consisted of 35 patients, where treatment was performed using traditional methods. Objective methods of studying the wound process have been applied: cytological, microbiological methods, an objective assessment of the wound process on the Bates-Jensen scale was performed, the dynamics of fibrinogen and C-reactive protein were studied.

RESULTS. During cytological examination in patients of the main group, in 82.9 % of cases, a regenerative type of smear-an imprint of a wound discharge was recorded, in the comparison group, the indicator was 51.4 %. By the 14th day of observation, according to the results of microbiological seeding, 88.6 % patient main group stopped isolating microorganisms from wounds, while in patients of the comparison group – 62.9 %. On the Bates-Jensen scale, on the 14th day of the study, the wound process in the main group was estimated at 22 points, in the comparison group, the dynamics of the wound process proceeded more slowly – 36 points. The level of fibrinogen and C-reactive protein in the blood decreases significantly faster in the main group compared to the comparison group.

CONCLUSION. The local effect of ultrasound waves has a positive effect on the regenerative processes in the wound, the elimination of microorganisms occurs, and the systemic inflammatory process decreases.

INTROUCTION. Hiatal hernias of types II–IV are a common pathology, in which the abdominal organs are displaced into the mediastinum through the hiatus esophagus parallel to the esophagus, which is an absolute indication for surgical treatment. The article presents five years of experience in surgical treatment of hiatal hernias of types II–IV at a multidisciplinary regional hospital.

THE OBJECTIVE WAS to analyze the long-term results of treatment of hiatal hernias of types II–IV.

METHODS AND MATERIALS. In the period from 2013 to 2017, 150 patients with hiatal hernias of types II–IV were operated on in the Department of Thoracic Surgery of the Murmansk Regional Clinical Hospital named after P.A. Bayandin. All patients underwent laparoscopic surgeries: elimination of hiatal hernia, cruroraphy, fundoplication. An assessment of the remote results of treatment, in periods of two to five years, was carried out in 116 (77.3 %) patients using clinical and instrumental examination: radiography of the esophagus, stomach with a contrast agent (BaSO4) and esophagogastroduodenoscopy.

RESULTS. A good long-term result was recorded in 79 (68.1 %) of 116 patients, satisfactory – in 6 (5.2 %), and unsatisfactory – in 31 (26.7 %) patients.

CONCLUSION. Retrospective analysis of the results of treatment of hiatal hernias of types II–IV makes us consider this problem to be far from being solved. The use of prostheses to correct the size of the hiatal opening does not always allow us to avoid relapse of the disease. To improve the remote results of treatment of this pathology, it is necessary to search for new tactical and technical approaches.

INTRODUCTION. Obesity is one of the most important problems of modern society, which requires the development of effective treatment methods. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive approach to the treatment of obesity, which makes it possible to achieve significant weight loss and improve metabolic parameters. However, to date, there have been no studies on this technique in Russia.

The OBJECTIVE was to evaluate the efficacy, safety, and aspects of the application of ESG using the example of two clinical cases.

METHODS AND MATHERIALS. We present four cases of patients with stage II and III of obesity who underwent ESG. The patients met the inclusion criteria determined based on the Brazilian Consensus on Indications and Contraindications for this procedure.

RESULTS. All patients demonstrated positive results after the procedure, including significant weight loss and improved quality of life without severe adverse events.

CONCLUSION. This study is the first in Russia to highlight the importance of ESG as a promising method of obesity treatment. Further research is needed to assess the long-term outcomes and safety of this procedure.

INTRODUCTION. Virtual ileostomy was proposed as an alternative to real ileostomy in low colorectal anastomoses. The use of the virtual ileostomy technique allows postponing the decision on the need to form a real ileostomy until the early postoperative period and performing this transformation only in patients with absolute indications. Analyzing our own experience of using virtual ileostomy according to the classical technique, we identified certain shortcomings in the virtual ileostomy technology, which led to an increase in the number of postoperative complications.

The OBJECTIVE was to improve the treatment outcomes of patients with rectal cancer who underwent low anterior rectal resection with coloanal anastomosis by using a new method for forming a virtual ileostomy.

METHODS AND MATERIALS. The article presents a comparative analysis of the results of treating patients with the classical method (CM) of forming a virtual ileostomy and with the technique developed in our clinic – new method (NM). The CM group included 40 patients, the NM group included 43 patients.

RESULTS. The study demonstrates a significantly higher number of postoperative complications in the CM group – 13 (32.5 %) versus 6 (14.0 %) in the nM group, p=0.04. The main difference was observed in the incidence of postoperative intestinal paresis: in the CM group – 6 (15.0 %), in the NM group – 1 (2.3 %), p=0.044. Among 83 patients in both groups, the incidence of anastomotic failure was 7 (8.4 %) cases, while no significant differences were found in the comparison groups.

CONCLUSION. Thus, the use of the virtual ileostomy formation technique developed by us significantly reduces the incidence of postoperative complications.

The article describes 8 cases of Bouveret’s syndrome, a rare form of obstructive duodenal obstruction caused by the migration of a large gallstone through a biliodigestive fistula. BS diagnosis is not significantly difficult when using EGDS. The need to use high-tech methods of radiation diagnostics, such as MRI or MSCT, rarely occurs. Treatment should start with an endoscopic intervention aimed at moving the calculus into the stomach, followed by lithotripsy and extraction. However, lithotripsy in the lumen of the duodenum carries the risk of distal movement of fragments, which can lead to the development of obstructive small intestinal obstruction. In the absence of the effect of endoscopic intervention, it is recommended to perform lithoextraction through gastric access, without intervention on the gallbladder.

This article illustrates a case of successful application of the Kuban Cuff technique for aortic valve (AV) reimplantation in a patient with DeBakey type I acute aortic dissection. A comprehensive surgical intervention was performed, including total aortic arch replacement and reconstruction of the brachiocephalic trunk, left common carotid, and left subclavian arteries. The operation allowed to preserve the native AV, which eliminated the need for lifelong anticoagulant therapy. Minimal complications were noted in the postoperative period, and on postoperative day 13, the patient was discharged in satisfactory condition. This case emphasizes the importance of individualized treatment strategies in acute aortic dissection and confirms the feasibility of valve-sparing procedures.

A rare clinical observation of the complication of recurrent hiatal hernia – gastro-pericardial fistula, accompanied by strained pneumopericardium is presented. The effectiveness of stage-by-stage surgical treatment is shown: drainage of the pericardial cavity and followed by left-sided thoracotomy, fistula separation, suturing of a stomach wall defect and drainage of the pleural cavity.

INTRODUCTION. The learning curve is a period, during which surgical skills are improved through various training and educational techniques. The duration of the learning curve is characterized by the minimum number of completed operations necessary to reach a plateau of satisfactory results. The speed and widespread use of minimally invasive technologies in various sections of surgery necessitate a detailed study of learning curves. It is important to study the process of mastering new surgical techniques, since it is associated with possible complications during surgical interventions. As the number of surgical interventions using robot-assisted technologies has increased, the importance of evaluating surgical skills has also increased. It is important to repeatedly evaluate the surgical skills of each surgeon who performs robot-assisted surgery to determine that surgeon’s current position on the learning curve.

The OBJECTIVE was to conduct a systematic review of the literature devoted to the analysis of the learning curve in robot-assisted surgical interventions.

METHODS AND MATERIALS. A systematic review of available scientific articles on this topic has been carried out. When searching for the necessary articles to conduct a literary review on this topic, such platforms as PubMed, Elibrary, BSMU Scientific Library, Cyber Leninka, etc. were used.

RESULTS. During the period from 2014 to 2024, 56 articles were studied during the literary review, of which 50 articles by foreign authors and 6 articles by Russian authors. Parameters such as the time of surgery, the amount of blood loss, the duration of the inpatient period, the frequency of complications, as well as the rate of recovery of patients after surgery and the quality of life of patients were evaluated.

CONCLUSIONS. Despite significant progress, a number of unresolved issues remain, such as the standardization of learning curve parameters and the development of unified approaches to assessing surgical skills. The introduction of training programs, the use of simulators, and mentoring are key factors contributing to reducing the learning curve and improving patient outcomes. Future research should focus on the development of standardized training protocols and the introduction of new technologies such as artificial intelligence to objectively evaluate surgical skills.

Introduction. The laparoscopic approach is the gold standard in colorectal cancer surgery. The formation of an anastomosis during laparoscopic right hemicolectomy is possible both extracorporeal and intracorporeal. However, the need for advanced intracorporeal suturing skills and concerns about the safety of intracorporeal anastomosis have limited its use in practice. Contradictory study results highlight the need for further research.

The objective of this study was to review the available literature and analyze the published studies for both intracorporeal anastomosis and extracorporeal anastomosis, focusing on surgical efficacy and safety.

Materials and Methods. Randomized trials were searched in electronic databases in PubMed, eLIBRARY, the Cochrane Library, and Google Scholar using predefined keywords. During the search and study of materials, 8 randomized controlled trials and 6 meta-analyses were included in the final review and analysis.

Results. An initial database search revealed a total of 1,502 papers. After removing duplicates and reviewing texts, eight randomized controlled trials and six systematic reviews and meta-analyses were analyzed. Surgery duration and treatment costs were comparable between intracorporeal and extracorporeal anastomosis groups. Intracorporeal anastomosis was linked to reduced surgical stress, shorter incision length, faster gastrointestinal recovery, and shorter hospital stays, without increased intra-abdominal complications. Extracorporeal anastomosis showed higher rates of wound infections, moderate intestinal paresis, and postoperative ventral hernias.

Conclusion. Intracorporeal anastomosis may be a viable alternative to extracorporeal anastomosis in laparoscopic right hemicolectomy. However, the limited number of studies leaves questions about their comparative advantages unresolved. 

The treatment of perianal Crohn’s disease remains a significant challenge due to the complexity of its pathogenesis and the lack of standardized treatment guidelines. The high rate of surgical failure, frequent exacerbations and recurrences, as well as the risks of anal incontinence and rectal strictures, highlight the need for more effective therapeutic strategies. This review examines various treatment approaches for pararectal fistulas in perianal Crohn’s disease. However, conflicting findings in the literature, the limited number of clinical studies, and the absence of standardized criteria for evaluating treatment outcomes make it difficult to draw definitive conclusions about the efficacy of existing therapeutic modalities. Further well-designed studies with a stronger evidence base are essential to establish optimal treatment strategies.