The article discusses the current problems of organizing modern surgical care in Russia. A historical analysis of surgery development over the past century was carried out. It was based on the S. P. Fedorov’s ideas expressed in his work “Surgery stands at the parting of the ways” (1926).
The focus is on the issue of providing high quality, high-tech, especially emergency, surgical care to the population of rural areas. It is demonstrated that modern regulatory requirements and the introduction of complex diagnostic technologies (CT, MRI, and angiography) have made it impossible to fully deploy them in every region, which has led to the need for resource concentration.
The introduction of a three-level system of specialized medical care is proposed as a strategic way to solve the problem. A key element is the creation of a network of inter-district «flagship specialized care centers» equipped with a full range of equipment for invasive surgery, designed to serve 150–200 thousand people. These centers should be integrated into a unified system of emergency medical care and medical evacuation with centralized dispatching, which will provide effective patient routing within the first 24 hours. According to calculations, such system will allow for providing the care to the majority of emergency patients (80%) at district hospitals, and ensuring timely evacuation of others to specialized centers.
The proposed model is considered as the development of the principle of staged treatment with evacuation by destination, which has proven its effectiveness in military field surgery.

An outstanding surgeon, traumatologist and neurosurgeon, scientist, teacher and organizer of healthcare, one of the founders of traumatology and neurosurgery in Russia, creator of the first large scientific and practical school of neurosurgeons in our country, founder and director of the Physiosurgical Institute (1917) and the first director of the State Traumatology Institute (1923) in Petrograd, organizer of the first in our country department of traumatology and orthopedics (1918), the first director of the Leningrad State Research Neurosurgical Institute (1938), Academician of the USSR Academy of Medical Sciences (1945), Honored Scientist of the RSFSR (1934), laureate of the Stalin Prize of the 1st degree (1946), Doctor of Medical Sciences (1901), Professor (1914). Andrei Lvovich Polenov was born on April 7 (April 19, new style), 1871, in Moscow to a noble family of the Polenov family, well known in Russia. In 1896, he graduated from the Military Medical Academy and served as a military doctor in Orel, then at the Kronstadt Naval Hospital. In 1901, he defended his doctoral dissertation «Sympathectomy. Its Effect on Experimental Epilepsy in Animals» at the Military Medical Academy. In 1917, A. L. Polenov organized the Physiosurgical Institute for the comprehensive treatment of war invalids and those injured in peacetime. In 1923, he was appointed director of the newly established State Traumatology Institute and published the first traumatology manual in the country. In 1935, he headed the first full-time neurosurgery department in Russia at the Leningrad State Neurosurgical Research Institute. In 1938, he was appointed director of the new Neurosurgical Institute. A.L. Polenov was the author and co-author of more than 150 scientific and practical works, including 12 monographs and manuals. He created the first school of neurosurgeons in our country and is considered the founder of neurosurgery in Russia. Academician A. L. Polenov died on July 19, 1947, in Leningrad and was buried at the Bolsheokhtinskoe Cemetery. That same year, the Leningrad State Neurosurgical Research Institute was named after A. L. Polenov.

The OBJECTIVE of our work was to implement and evaluate the results of hybrid reconstructions in the treatment of patients with critical lower limb ischemia caused by extensive occlusive lesions of the femoral and lower leg arteries.
METHODS AND MATERIALS. Over a two-year period, we performed 24 hybrid reconstructions for infrainguinal lesions. The follow-up period was 12 months. 17 patients underwent classic femoropopliteal bypass grafting using the great saphenous vein below the knee joint space and balloon angioplasty of the crural arteries. In 7 patients, a modified operation was performed, including popliteal-distal bypass grafting with an autovein with antegrade semi-closed remote endarterectomy from the superficial femoral artery using balloon angioplasty of the crural artery and, if necessary, stenting of the external femoral artery.
RESULTS. Primary arterial patency over 12 months of follow-up was 83.3 %. Secondary patency was 92 %. Limb preservation was 92 %.
CONCLUSIONS. Hybrid interventions including femoropopliteal autovenous bypass or a modified method (in the absence of a suitable autovein), as well as endovascular correction of outflow tracts, can take a worthy place in the treatment of patients with chronic limb-threatening ischemia, developed against the background of extended occlusive lesions of the femoropopliteal arterial segment.

INTRODUCTION. The problem of treating pressure ulcers of the greater trochanter of the femur in patients with consequences of spinal trauma remains the focus of close attention of clinicians and researchers. The complexity of the problem is primarily due to the high percentage of postoperative complications and relapses. The causes of unfavorable treatment outcomes are often defects in preoperative preparation, sometimes – imperfection of the surgical techniques chosen for treatment. Studying the spectrum of complications and predictors of pressure ulcer relapse is necessary for qualitative growth of the effectiveness of surgical treatment.
The OBJECTIVE was to systematize the literature data and, based on the data of our own clinical study, to evaluate the effectiveness of various types of reconstructive plastic surgeries used to close the pressure ulcer of the greater trochanter of the femur in patients with spinal trauma.
METHODS AND MATERIALS. The literature sources focused on surgical treatment of pressure ulcers of the projection of the greater trochanter of the femur were analyzed.
An analysis of surgical treatment of 61 patients who underwent elective surgery for pressure ulcers of the projection of the greater trochanter of the femur was conducted. The following surgical techniques were used: spoke dermotension, plastic surgery with a free split graft, plastic surgery using two types of local skin-fat flaps and a TFL flap.
RESULTS. Analysis of literature data showed that the main method of treating pressure ulcers is surgery. However, the known reconstructive plastic surgeries are far from ideal, since their use leads to such formidable complications as wound infection (from 35 to 50 %), flap ischemia (17 %), flap necrosis (12.5 %), postoperative hematomas, seromas, which are predictors of relapses. In this regard, the «best option» for treating pressure ulcers remains a subject of search.
A prospective study showed that among all operated patients, the most common complications in the postoperative period were flap ischemia, wound infection, suture failure, and lymphorrhea. Such complications were recorded in 21 (34 %) of 61 patients operated on for pressure ulcers of the trochanteric region.
CONCLUSION. The method of choice for treating patients with extensive pressure ulcers is reconstructive plastic surgery, which is based on the formation of skin-fat flaps and rotational skin-fascial flaps with the principles of tension-free plastic surgery. At the same time, the issue of complications such as flap ischemia, lymphorrhea and wound infection remains unresolved, which requires further scientific and practical research.

INTRODUCTION. Recurrent hiatal hernias are a separate problem of surgery. The scientific community has no generally accepted views on the indications for repeated operations for this pathology, their ideology and technical principles. The results of surgical treatment of recurrent hiatal hernias presented in the literature are also different. The OBJECTIVE was to present his own experience in the treatment of recurrent hiatal hernias.
METHODS AND MATHERIALS. The article presents a ten-year experience of revision operations for recurrent hiatal hernias in 96 patients at Pavlov First Saint Petersburg State Medical University. The majority patients (56 – 58.3 %) were initially operated on in other clinics. In 31 (32.3 %) patients, the primary hernia was axial, in 37 (38.5 %) – paraesophageal or mixed type. In 28 (29.2 %) cases, the type of hernia was unknown. Primary plastic surgery using own tissues was performed in 89 patients (92.7 %), in 7 (7.3 %) – using prostheses. Indications for reoperation were not responded to drug therapy gastroesophageal reflux or food transport disorders (“gastric valve”).
RESULTS. Laparoscopic access was used in 92 (95.8 %) cases, left-sided thoracotomy – in 4 (4.2 %) cases. Remote treatment results were assessed in 79 patients (82.3 %). A good outcome – absence of anatomical and clinical recurrence of the hernia – was noted in 64 cases (77.7 %). Repeated stomach dislocation into the thoracic cavity with the resumption of clinical symptoms was found in 15 patients (22.3 %).
CONCLUSION. The presented data illustrate the complexity of the problem of surgical treatment of recurrent hiatal hernias and the need to search for new approaches to the solution.

Endometrial cancer (EC) is the most common gynecological cancer, and obesity is recognized as one of the key factors in its development. A significant increase in the EC risk has been confirmed in women with BMI>40 kg/m2. The main points concerning the EC risks in obesity, methods of risk modification and approaches to cancer treatment in obese patients are presented. Despite the fact that the use of minimally invasive methods, sentinel lymph node mapping, ERAS and Fast Track programs can minimize complications and improve outcomes, surgical intervention in patients with morbid obesity is associated with technical difficulties, including limited access to the pelvic organs, a high risk of intraoperative and postoperative complications, as well as prolongation of anesthesia time. Abdominoplasty and panniculectomy may be useful for improving surgical access and reducing risks in this category of patients. The clinical observations of female patients underwent abdominoplasty in combination with uterine extirpation and lymphadenectomy are presented. The use of abdominoplasty in pronounced panniculus helps to improve the quality of the surgical stage, does not contradict the use of video endoscopic access.

METHODS AND MATERIALS. Between 2009 and 2025, BMT was used in 37 patients. In 15 patients, non-anastomotic strictures developed 4-106 (on average 17) months after OLT; in 22 patients, strictures were noted after 2-139 (on average 19) months after biliary surgery. After percutaneous biliary drainage, balloon dilatations were performed until disappearance of stricture. Upon achieving a positive X-ray result, BMT was performed.
RESULTS. Patients (n=37) received 180 (2–17, mean 6) procedures. BMT was performed after on average 10 (6–17) months. Treatment continues in 4 patients. Technical success was achieved in 30 of 33 patients (90 %), and their biliary drainage was removed in 8–22 (mean 11) months. Stricture recurrence developed in 2, also treatment was ineffective in 3; all 5 these patients underwent successful surgical biliary reconstruction. Thus, clinical success was achieved in 28 of 33 patients (85 %). Follow-up periods range from 12 to 172 (on average 51) months, with no signs of biliary hypertension. Adequate 1-yr and 4-yr biliary decompression was 100 % and 93 % after removal of the drainage on the basis of BMT.
CONCLUSION. BMT seems to be objective method to control effectiveness of balloon cholangioplasty for postoperative benign biliary strictures. In cases of good result of BMT, full 4-yr patency persists in 93% of patients.

The article demonstrates approaches to the diagnosis and treatment of intestinal endometriosis with a complication in the form of intestinal bleeding. In the first case, intestinal bleeding in a young woman was caused by endometriosis through germination of the sigmoid colon wall, which is a classic example of a combined lesion of endometriosis of the pelvic organs. The second case describes a rare variant of intestinal bleeding caused by endometriosis of the duodenum in a woman during the menopausal transition.

The OBJECTIVE of the study was to analyze the long-term results of the use of modified aortic valve reimplantation in patients with aortic root and ascending aortic aneurysms.
METHODS AND MATERIALS. From 2011 to 2024, 79 patients underwent surgery for ascending aortic aneurysm with aortic valve (AV) insufficiency using modified reimplantation of aortic valve (MRAV). The control groups were: 80 patients with Bentall procedure and 51 patients who underwent .
RESULTS. The average age of patients in the MRAV group was 61 years (53-68). The average diameter of the aorta in the study group was 55 mm, in the Bentall group 54 mm and in the David group 60 mm. The average diameter of the AV fibrous ring in the study group was 24.7 before surgery and 22.5 after surgery, compared with the Bentall group, where the average diameter of the AV was 25.1 before surgery (p=0.189) and 21.9 after surgery (p=0.120). The average diameter of the AV in the David group was 23.1 before surgery (p=0.603) and 22.0 after surgery (p=0.213). In the long–term period, freedom from aortic regurgitation after 5 years was 79% for the David group and 92% for the MRAV group. After 10 years, this indicator decreased to 51.8% in the David group and 79.7% in the MRAV group. The survival rate of the compared groups after 5 years was 88.6% in the MRAV group with a slight decrease to 83% after 10 years; in the David group – 86.1% with a significant decrease to 54.4% after 10 years. In the Bentall group, the survival rate after 5 years was 88.5%. After 10 years, this indicator in this group had not changed.
CONCLUSION. This study shows that the proposed technique can be performed with good immediate and long-term results. The technique is relatively simple and reproducible.

INTRODUCTION. This study examines the impact of the degree of interventricular septum reduction (<5 mm and ≥5 mm) on outcomes following alcohol septal ablation.
METHODS AND MATERIALS. Data from 597 patients with obstructive hypertrophic cardiomyopathy who underwent alcohol septal ablation were analysed. Patients were divided into two groups: septal reduction <5 mm (329 patients); septal reduction ≥5 mm (268 patients). To correct the imbalance between the groups, the propensity score matching method was used. Outcomes were studied in both matched and unmatched cohorts.
RESULTS. In the long-term follow-up period, 63 deaths were recorded. In the group with ≥5 mm reduction, gradients of the left ventricular outflow tract were lower (p<0.0001). Residual obstruction was more frequently observed in the <5 mm reduction group: unmatched cohort: 87 (26 %) vs. 37 (14 %), p<0.0001; matched cohort: 66 (33 %) vs. 21 (10 %), p<0.0001. Long-term survival was statistically significantly lower in the<5 mm reduction group: HR 0.47 (95 % CI: 0.24–0.89), p=0.019.
CONCLUSION. Septal reduction of less than 5 mm following alcohol septal ablation is associated with: higher gradients of the left ventricular outflow tract; a higher incidence of residual obstruction; worse long-term survival.

The OBJECTIVE was to evaluate the results of endovascular reconstruction in patients with dialysis-dependent ischemic kidney disease caused by bilateral renal artery disease.
METHODS AND MATERIALS. From October 2017 to September 2024, in the Department of Vascular Surgery of the Pavlov First Saint Petersburg State Medical University, 174 patients (100 men and 74 women, mean age 65±7 years) underwent endovascular reconstruction of renal arteries, including 3 (2 %) patients with dialysis-dependent ischemic kidney disease. Preoperative examination of patients included an assessment of clinical manifestations, laboratory parameters (serum creatinine and urea levels, estimated glomerular filtration rate), ultrasound examination of the kidneys with an assessment of the thickness and condition of the parenchyma, parameters of extrarenal and intrarenal arterial blood flow (peak systolic blood flow velocity, resistivity indices), and performing catheter arteriography and/or CT angiography. In patients with dialysis-dependent ischemic kidney disease, indications for revascularisation were the hemodynamically significant damage to both renal arteries and signs of preserved renal parenchyma viability. In the immediate and late postoperative period, renal function was assessed based on clinical, laboratory, and instrumental data.
RESULTS. Bilateral hemodynamically significant (stenosis > 50 % or occlusion) renal artery lesions were detected in 69 (40 %) patients. Clinical observations of 3 (2 %) patients are presented, in whom restoration of patency of one or both renal arteries through endovascular reconstruction allowed discontinuing haemodialysis.
CONCLUSION. In the presented case series with occlusive-stenotic lesions of the renal arteries, 2 % of patients had a dialysis-dependent form of ischemic kidney disease. Timely endovascular reconstruction of the renal arteries in such patients can lead to regression of renal dysfunction and discontinuation of renal replacement therapy.

An important trend in recent armed conflicts and terrorist attacks is the widespread use of explosive ammunition, which is accompanied by the impact of damaging elements with high kinetic energy on the body of the victims. Therefore, the distinctive features of modern abdominal gunshot trauma are the combined nature and severe multi-organ damage, requiring intensive care and specialized surgical care in the shortest possible time. The key to its successful implementation is preoperative diagnostics of injuries. An adequate assessment of their localization and nature allows to develop an operation plan and thereby minimize the risks of “surgical surprises”, and, if necessary, include specialists of the appropriate profile in the team. However, solving this problem is associated with significant difficulties due to the lack of time, as well as multiple injuries to internal organs. In addition, problems may be due to anomalies in their development, which significantly complicate the assessment of the topographic features of abdominal gunshot trauma. The article presents the experience of providing specialized surgical care for severe combined pelvic abdominal injury and a rare anatomical anomaly – pelvic dystopia of the left kidney. It is demonstrated that a comprehensive preoperative examination using CT imaging, along with timely planning of stages of the surgical intervention, provides good treatment results for this difficult category of patients, allowing to preserve the organ compromised by injury and developmental anomaly.

Hybrid vascular surgery represents a promising approach to treating occlusive atherosclerosis, combining endovascular and open surgical methods. This review examines the evolution and definition of hybrid interventions, phenotypic features of multifocal lower extremity arterial disease, outcomes from major trials, contemporary surgical treatment approaches, and prospects for novel interventions, as well as potential complications and their management.

The article presents a retrospective view of creating the national clinical guidelines «Acute Pancreatitis». All details of the issue are covered step by step, starting with the historical aspects of the first attempts to systematize knowledge about acute pancreatitis to modern structured treatment and diagnostic algorithms. The approaches of surgical communities in different eras of medical development to solving issues of classification, diagnosis and treatment of acute pancreatitis are described. Special attention is given to the role of the Saint Petersburg Research Institute of Emergency Medicine named after I. I. Dzhanelidze in creating of the first protocols for the diagnosis and treatment of acute pancreatitis, which later became the “foundation” for the creation of modern national guidelines.