An outstanding surgeon, scientist, teacher and organizer of healthcare, the founder of one of the largest scientific and practical schools of vascular surgeons and angiologists in the USSR and Russia, Academician of the Russian Academy of Medical Sciences (1997) and the Russian Academy of Sciences (2013), laureate of the USSR State Prize (1975), the Russian Federation State Prize (2002), the Russian Federation Government Prize in Science and Technology (2004), the A. N. Bakulev Prize (2001), president of the Russian Society of Angiologists and Vascular Surgeons (until 2019), president of the European Society for Vascular Surgery (ESVS) (2000), Doctor of Medical Sciences (1967), Professor (1968) Anatoly Vladimirovich Pokrovsky was born on November 21, 1930 in Minsk into a family of doctors. In 1953, he graduated from the 2nd Moscow Medical Institute named after N. I. Pirogov. In 1958, he defended his candidate’s dissertation «On the issue of intrathoracic anesthesia during heart surgery». In 1961 – senior research fellow in the vascular surgery department, and from 1964 to 1983 – head of the department of surgery of the great vessels of the A. N. Bakulev Institute of Cardiovascular Surgery. In 1967, he defended his doctoral dissertation «Surgical treatment of coarctation of the aorta» and in 1968, he received the academic title of Professor. In 1983, A. V. Pokrovsky transferred to work at the A. V. Vishnevsky Institute of Surgery of the USSR Academy of Medical Sciences as the head of the largest vascular surgery department in the country, and in 1986, he was elected by competition as the head of the department of clinical angiology and vascular surgery at the Central Order of Lenin Institute for Advanced Medical Studies (now the Russian Medical Academy of Postgraduate Education). In 1997, Anatoly Vladimirovich was elected a full member of the Russian Academy of Medical Sciences. Academician A. V. Pokrovsky is rightfully considered one of the founders of the Soviet school of vascular surgeons and angiologists. Under his supervision, 167 dissertations were defended (56 doctoral and 111 candidate dissertations). He was the author and co-author of more than 720 scientific and practical works, including 16 monographs and manuals. In 1992, Anatoly Vladimirovich created the Russian Society of Angiologists and Vascular Surgeons, of which he was the permanent president until the end of his life. A. V. Pokrovsky became widely known abroad. He was elected an honorary member of the American Society for Vascular Surgery, a member of scientific societies in Germany, Hungary, Poland, and Bulgaria. Anatoly Vladimirovich was a member of the International Association for Cardiovascular Surgery, the World Society of Angiology. For the first time in the history of our country, in 2000, Academician A. V. Pokrovsky was elected President of the European Society for Vascular Surgery. For many years, he was a member of the editorial board of the journals Cardiology, Surgery, Cardiovascular World Report, and European Journal of Vascular and Endovascular Surgery. Academician Anatoly Vladimirovich Pokrovsky died on June 2, 2022, and was buried in Moscow at the Danilovskoye Cemetery.

INTRODUCTION. The number of patients with obesity and coxarthrosis increases progressively every year. However, there is currently no consensus on the tactics of preoperative management of patients with obesity and osteoarthritis of the hip joint.
The OBJECTIVE of our research was to study the effectiveness of conservative and surgical treatment of morbid obesity in patients with coxarthrosis.
METHODS AND MATERIALS. A retrospective single-center cohort study was conducted, patients with coxarthrosis were examined who were referred to the clinic for total hip arthroplasty, while the patients had a history of morbid obesity (body mass index over 40 kg/m²) before hospitalization. The cohort consisted of 115 patients, 29 men (25.2 %) and 86 women (74.8 %), the average age was 64.2±6.9 years, the average body mass index was 44.3±2.7 kg/m2. Two groups of patients were selected: 56 patients (study group I) with diagnosed coxarthrosis and morbid obesity, who voluntarily underwent conservative treatment of obesity in outpatient settings at their place of residence; the second group (group II) included 59 patients with coxarthrosis who underwent bariatric surgery.
RESULTS. Conservative treatment of morbid obesity in the presence of a primary effect of 5 % of BMI (3 months) gives a maximum weight loss by 9 months after the start of treatment, reaching 13 % (38.7±1.1 kg/m²) of the initial average. BO cause weight loss of up to 28.9 % by 6 months (32.1±1.0 kg/m²) and subsequently stabilize at about 20 % of the initial BMI.
CONCLUSION. Conservative treatment of morbid obesity in patients with coxarthrosis gives maximum weight loss by 9 months after the start of treatment, reaching 13 %, after bariatric surgery for 6 months there is a maximum weight loss of up to 28.9 % of the initial average BMI of patients.

INTRODUCTION. Small intestine injuries from gunshot wounds of the abdomen are detected in 41–60 % of cases and are accompanied by the development of life-threatening complications: ongoing intra-abdominal bleeding (20.4–60.0 %), widespread peritonitis (31.0–60.0 %), sepsis (14.3–21.7 %), eventration (8.6–9.5 %). The current level of injury surgery development fundamentally includes two tactical solutions for such wounded: single-stage surgical treatment (SSST) and multi-stage surgical treatment (MSST). The advantages and disadvantages of using these surgical approaches at the evacuation stages are still being debated, which is explained by the lack of reasonable indications for choosing each of them. Nevertheless, the incidence of postoperative complications (24.5–42.2 %) and the mortality rate (6.8–53.3 %) remain high.
The OBJECTIVE was to analyze the results of surgical care for patients with gunshot wounds of the abdomen with damage to the small intestine at the stages of medical care and identify reliable criteria that influence the choice of surgical tactics.
METHODS AND MATERIALS. The results of treatment of 104 patients with gunshot wounds of the small intestine at various stages of evacuation in military medical organizations (MMO) and admitted to the Clinic of Faculty Surgery named after S. P. Fedorov at the Military Medical Academy from March 2022 to May 2024 were analyzed. The wounded were divided into 2 groups, depending on the used treatment tactics: 1st (n=29/27.9 %) – patients who underwent SSST; 2nd (n=75/72.1 %) – patients who were used MSST tactics. All calculations were performed using Microsoft Excel 2007 and IBM SPSS Statistics 27 software.
RESULTS. It was found that the most serious complications of surgical treatment of the wounded with gunshot wounds of the abdomen with damage to the small intestine upon admission to a specialized stage of treatment in groups 1 and 2, respectively, are: failure of intestinal sutures – 10.3 % and 13.4 %, the development of acute perforated ulcers of the small intestine – 6.9 % and 9.3 %, the formation of entero-atmospheric fistulas – 0 % and 2.7 %, leading to the development of secondary peritonitis – 13.8 % and 20 %, abdominal sepsis – 6.9 % and 6.7 %, septic shock – 6.9 % and 2.7 %. Mortality in groups 1 and 2 was 3.4 % and 4.0 %, respectively. The main reliable criteria influencing the choice of surgical tactics at the stages of medical evacuation are highlighted: the general condition of the wounded according to the MFS-AS scale (p<0.001), the severity of damage to the small intestine according to the AAST-OIS classification (p=0.007), the development of widespread peritonitis with systemic inflammatory reaction syndrome (SIRS) (p=0.012), late delivery (more than 13 hours after injury) of qualified surgical care (p=0.003) and non-compliance with the principles of intestinal and intraabdominal decompression during surgical care (p<0.002). Extrapolation of the data obtained to the victims of the studied groups allowed us to establish indications for the use of MSST tactics in 75 % of the wounded, including 3.8 % with primary enterostomy. The remaining 25 % of the wounded had relative indications for damage control tactics and could be operated on in one stage for wounds with grade I–II small intestine damage according to the AAST-OIS classification and the average general condition of the patient (on the MFS-AS scale), in the absence of widespread peritonitis with SIRS, as well as a favorable medical and tactical environment.
CONCLUSION. The refinement of reliable criteria and their use in determining treatment tactics in the wounded with damage to small intestine ensure not only the differentiation of surgical approaches at the stages of medical care, but also improve the results of treatment of victims.

The OBJECTIVE was to develop, validate, and implement a clinical and laboratory model based on machine learning (ML) for the early identification and timely prevention of postoperative complications in patients who have undergone bariatric surgery.
METHODS AND MATERIALS. A retrospective analysis was performed on clinical data from 2,011 patients who underwent bariatric procedures. The study included demographic characteristics, clinical symptoms, laboratory findings, imaging results, and details of the postoperative course. A logistic regression model was constructed using automatic class weighting to correct for class imbalance and improve predictive accuracy. The model’s performance was evaluated using key metrics: AUC, accuracy, sensitivity, specificity, and F1-score.
RESULTS. The developed model demonstrated high predictive performance (AUC=0.975, accuracy=94.8 %, sensitivity=93.1 %). The most significant predictors of postoperative complications were elevated C-reactive protein levels, tachycardia, fever, symptom severity, and inflammatory laboratory markers.
CONCLUSION. The proposed machine learning model shows substantial potential for integration into clinical practice and may serve as a foundation for developing intelligent systems for early complication warning, automated monitoring, and clinical decision support.

INTRODUCTION. Hiatal hernias occur in 10 % of young adults and 50–60 % of older adults. Types II–IV hernias account for 15 % of cases. Characteristics of this type of anatomical abnormality include a large hiatal opening, significant destruction of the ligamentous apparatus that holds the stomach in place, and, often, a shortened esophagus. The clinical significance and indications for surgical treatment of types II–IV hiatal hernias are determined by the resulting dysfunction of organs displaced into the mediastinum due to their rotation or compression within the hiatal opening. A high recurrence rate, reaching 20–40 % and even 60 %, remains an unresolved issue in this area of practical medicine. This situation dictates the need for solutions.
METHODS AND MATERIALS. This article presents an analysis of the long-term treatment outcomes of 330 patients with types II–IV esophageal hernias. These patients were treated in the Thoracic Surgery Department of the Murmansk Regional Clinical Hospital named after P. A. Bayandin. The patients were divided into two groups. The retrospective group consisted of 150 patients who underwent surgery from 2013 to 2017 according to generally accepted principles. For hiatal hernias up to 5 cm in size, they were repaired using their own tissues; for larger hiatal hernias, they were reinforced with a mesh prosthesis anterior and posterior to the esophagus. Fundoplication was performed to prevent gastroesophageal reflux. The prospective group included 180 patients who underwent surgery from 2018 to 2024, taking into account the analysis of unsatisfactory treatment outcomes in the retrospective group. The modified strategy focused on esophageal shortening, a significant factor in the primary occurrence of this type of hernia and its recurrence after surgery. In patients with esophageal shortening in the retrospective group, the hiatal orifice was always repaired using the patient’s own tissue, and the fundoplication cuff was formed in the mediastinum. In patients with normal esophageal length, the strategy was the same as in the retrospective group.
RESULTS. The duration of surgery, hospital stay, and incidence of intraoperative and early postoperative complications were similar in both groups. Comparison of long-term treatment outcomes revealed a decrease in the incidence of unsatisfactory outcomes (anatomical and clinical recurrence) to 11.4 % in the prospective group compared to 26.7 % in the retrospective group.
CONCLUSION. Changing surgical treatment tactics for types II–IV esophageal hernias, taking into account the shortening of the esophagus, has reduced the incidence of unsatisfactory surgical outcomes by more than half.

INTRODUCTION. In surgical treatment of early peripheral lung cancer, accurate intraoperative visualization of the tumor and determination of tumor growth boundaries remain a problem.
The OBJECTIVE was to develop a methodology and analyze the first results of intraoperative infrared fluorescence diagnosis of lung neoplasms.
METHODS AND MATERIALS. The study included 27 operated patients with lung neoplasms of various histological types. Each patient immediately after performing access, as well as on the ex vivo, underwent an attempt at fluorescence imaging of the removed tumors in the near-infrared spectrum, as well as the presence of other foci of fluorescence. The fluorescence intensity was quantified. Indocyanine green lyophilizate with Human Albumin 20 % was used as a fluorescent agent, and the MMC SCOPE ICG system was used to visualize infrared fluorescence.
RESULTS. Infrared fluorescence was used to visualize 21 out of 31 (68 %) neoplasms in 20 out of 27 (74 %) patients. When comparing fluorescent and non-fluorescent foci, there was no correlation between the presence of fluorescence and the histological structure, the size of the neoplasms and the presence of invasion of the visceral pleura. Fluorescence diagnostics also revealed in 3 patients (11 %) an additional 4 CT-negative foci ranging in size from 0.5 to 10 mm, all of which turned out to be malignant tumors.
CONCLUSION. The method of fluorescent intraoperative diagnosis is safe and informative, it allows to visualize intrapulmonary neoplasms in 74 % of patients, as well as to identify Rg-negative tumor foci in 11 % of patients.

INTRODUCTION. This article describes a monoportal endoscopic technique for surgical treatment of blind pelvic gunshot wounds.
The OBJECTIVE was to evaluate the possibilities and effectiveness of monoportal endoscopic surgery for blind pelvic gunshot wounds.
METHODS AND MATERIALS. The sample consisted of 16 men, aged 21–54, with blind pelvic gunshot wounds without damage to organs and large vessels, operated in 2022–2023 at the Military Medical Academy using monoportal endoscopic technology. The catamnesis was 12 months.
RESULTS. The operative technique of monoportal endoscopy in a liquid medium of sodium chloride saline solution with an antiseptic has been demonstrated, which makes it possible to remove a wounding projectile and clean a gunshot wound. In all patients, wound healing occurred within 5 to 16 days on the background of antibacterial therapy. There were no infectious complications. In all cases, a satisfactory clinical result was achieved. A computed tomographic classification of blind pelvic gunshot wounds is proposed for planning endoscopic access to a foreign body.
CONCLUSION. The method of full-endoscopic intra-wound debridement of gunshot wounds makes it possible to effectively remove wounding projectiles (bullets, shrapnel, fragments) from the musculoskeletal structures of the pelvis, providing satisfactory clinical outcomes. The optimal conditions for the use of this surgery are the presence of indications for the removal of deeply localized small foreign bodies in the pelvic area.

The article is devoted to the treatment of patients with choledocholithiasis. The issues of treatment of complex choledocholithiasis – an unremovable calculus of the common bile duct were considered. The results of 7 patients with complex choledolithiasis were analyzed. A method of stenting the common bile duct was proposed; when analyzing the results, it was noted that the size of the stones decreased in most patients – during rehospitalization, stones were not found in 2 patients, in the remaining 5 patients, stones were removed; a conclusion was made about the effectiveness of the staged treatment of patients in such situation.

Today, sepsis remains one of the significant problems in the world of medicine. The high incidence of development and mortality determines this pathology as one of the most dangerous complications. The problems of early diagnosis and selection of optimal treatment tactics remain the most relevant in the treatment of sepsis. The presence of a large number of different definitions and classifications also aggravates early diagnosis. This article presents the treatment tactics for an injured woman with a craniomaxillofacial trauma resulting from a fall from a height, complicated by sepsis, with a positive outcome.

This clinical case demonstrates the feasibility of successful surgical treatment for a patient with severe ACTH-ectopic syndrome complicated by HIV infection. Understanding the specific characteristics of HIV infection in cancer patients allowed us to effectively perform surgery, predict the severity of the postoperative period and, consequently, implement appropriate preventive measures for successful cure of the patient.

The occurrence of restenosis and pseudoaneurysms after carotid endarterectomy is particularly dangerous, since it often requires repeated revascularization. There are various ways to treat these complications, and there is still no unified treatment strategy for these types of complications. This clinical case represents the experience of successful surgical treatment of internal carotid artery partially thrombosed aneurysm with restenosis using a vascular homograft in a patient after primary carotid endarterectomy.

INTRODUCTION. Isolated coronary slow-flow phenomenon, being a lesion of the distal microvascular bed, may have an unfavorable prognosis, but usually does not require surgical revascularization. The genesis of delayed coronary flow in patients with symptomatic stenotic coronary lesion requires special attention in terms of surgical tactics, as it is not reversible in all cases.
The OBJECTIVE of the research was to study the coronary slow-flow phenomenon in a model of long-term chronic infection. METHODS AND MATERIALS. 68 patients with pulmonary tuberculosis with clinical or instrumental data of myocardial ischemia, but without coronary artery stenosis were studied. All patients were divided into 2 groups (with and without coronary slow-flow phenomenon). A modified TIMI scale was used to estimate the velocity of the radiopaque substance. The duration of the disease and the extent of the lesion, acute-phase blood parameters, and the presence of cardiotoxic drugs in therapy were evaluated.
RESULTS. Patients in the group with slowing of coronary flow had a longer duration of the disease, were characterized by a large volume of lung damage, however, there were no differences in the degree of increase in acute phase parameters of blood, the factor of bacillus excretion.
CONCLUSION. The presented data indicate the need to take into account the possible presence of a coronary slowflow phenomenon unrelated to the degree of stenosis in the tactics of surgical treatment of patients with a specific inflammatory process with symptomatic stenotic lesions of the coronary arteries.

Lung torsion is a rare but life-threatening complication and occurs in 0.09–0.4 % of cases after lung resections and in 4 % of postoperative complications due to lung tumors. Partial torsion is a 90–degree rotation of the lung, while complete torsion is 180 degrees or more. Torsion is caused by excessive mobility and a long bronchovascular pedicle of the lobe. Pulmonary torsion generally involves hilar structures and may cause ischemia, infarction, and necrosis of the lung. 70 % of all lung torsions are middle lobe torsions after right upper lobectomy. On the chest X-ray, opacities of the upper lung field appears from 1-3 days after surgery. Signs of torsion according to computed tomography are ground glass opacities and consolidation, interlobular septal thickening, devascularization of the middle lobe, obliteration of the middle lobe bronchus. Bronchoscopy can show of unusually angled and obstructed middle lobe bronchus. Suspected lung torsion requires immediate surgical reintervention. If the torsion lobe is congested but viable with no necrosis, lung detorsion without resection is possible. The danger of detorsion of the twisted lobe is associated with the risk of thromboembolism on the background of pulmonary vein thrombosis, pulmonary edema during reexpansion, vascular complications, acute respiratory distress syndrome, multiple organ dysfunction and sepsis due to ischemic necrosis of the remaining lung. If the middle lobe is not viable due to infarction, necrosis and gangrene, it must be removed. In case of high risk, to prevent torsion, it is proposed to use collagen film with fibrin glue, synthetic polymer glue Coseal, hemostatic plates TachoSil, Hemopatch, fix with nodal or stapler sutures to the other lobe. Timely repeated operation for torsion of the lobe provide a favorable outcome.

Despite the reduction of mortality in the treatment of patients with burn injury, even with a large area of tissue damage, a significant proportion of victims (from 30 % to 91 %) still have consequences in the form of pathologic scarring with the formation of joint contractures, itching and pain, as well as changes in psychosomatic status. A review of domestic and foreign literature was conducted to study modern approaches and trends in the treatment of pathologic scarring of post-burn wounds. The questions of epidemiology, pathogenetic reactions in the formation of pathologic scars, various approaches to therapy, including modern methods such as: plasma radiofrequency ablation, laser therapy and micropiling, medication, physiotherapeutic and surgical methods of treatment were considered. Scales and questionnaires for assessing the scar process, the patient’s condition and the effectiveness of treatment dynamics were exemplified. Further development of prevention and treatment of pathologic post-burn scars is considered on the way of deepening the understanding of the occurring molecular mechanisms in the scarring process, qualitatively planned and conducted studies to confirm the effectiveness of treatment.

Adhesive disease of the abdominal cavity is an urgent and completely unresolved problem in modern surgery. The first mentions of intestinal obstruction have been known to history since ancient times. The first and fundamental stage in the study of adhesive disease is the empirical period, the beginning of which dates back to the 17th century. During this period, there was an unsystematic accumulation of knowledge; scientists and surgeons put forward theories and assumptions about the causes of adhesions. The next historical period in approaches to the treatment of patients with intestinal obstruction of adhesive origin is the period of active surgical tactics. With the increase in surgical activity in the heyday of surgery since the end of the 19th century, the increase in patients with adhesive disease of the abdominal cavity is inextricably linked, and as a result, a disease such as intestinal obstruction, the cause of which was intraperitoneal adhesions, became widespread. At the end of the 20th century, endovideosurgery became very popular and widespread in surgery. Laparoscopic adhesiolysis had a number of important advantages compared with open surgery. Thus, the next historical stage in the treatment of patients with adhesive intestinal obstruction was the preference for laparoscopic surgical techniques. Currently, the surgical community is inclined to change the paradigm in the treatment of patients with adhesive disease, which consists of minimizing the surgical component in the treatment of patients in this group with an emphasis on a conservative approach, as well as paying attention to the prevention of adhesive disease. Currently, both in foreign and domestic literature, one can find a colossal amount of work on the search for new therapeutic and diagnostic techniques, the use of methods for preventing adhesions, and a comparative analysis of already known treatment algorithms. However, today there is no consensus on the tactics of managing patients with adhesive intestinal obstruction, which requires further study of the problem and finding ways to solve it.