[Unformed conglomerate debilitating jejunal fistulas and their two-stage surgical treatment via posterolateral laparotomy]. / Nesformirovannye konglomeratnye istoshchayushchie toshchekishechnye svishchi i ikh dvukhetapnoe khirurgicheskoe lechenie iz zadnebokovogo laparotomnogo dostupa.

OBJECTIVE: To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications. MATERIAL AND METHODS: Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative. RESULTS: Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% (t=11.8; p<0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis. CONCLUSION: A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

[Improving surgical technique for tracheal resection with anastomosis]. / Usovershenstvovanie khirurgicheskoi tekhniki pri rezektsii lineinoi chasti trakhei s posleduyushchim anastomozom.

OBJECTIVE: To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS: The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION: Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.

[Living related liver transplantation in the Republic of Uzbekistan: current status and development prospects]. / Rodstvennaya transplantatsiya pecheni v Respublike Uzbekistan: nyneshnee sostoyanie i perspektivy razvitiya.

OBJECTIVE: To analyze primary results of living related liver transplantation in the Republic of Uzbekistan. MATERIAL AND METHODS: There were 44 living related transplantations of the right liver lobe in patients with decompensated liver failure between February 2018 and February 2023. RESULTS: Uneventful postoperative period was observed in 17 (38.6%) recipients. Other 27 patients (61.4%) developed 47 various postoperative complications (1-3 events per a patient). Of these, 8 (18.2%) patients required early postoperative re-laparotomy. Among 44 patients, 9 (20.5%) ones died in early postoperative period, and one patient died in long-term period (3 years after transplantation) from chronic rejection under refusal to take immunosuppressive drugs. Early satisfactory results were obtained in 79.5% of patients, long-term favorable outcomes - in 77.3% of cases. CONCLUSION: Engraftment rates and survival of recipients to a large extent depend on surgical strategy, baseline disease and clinical severity. The so-called "center effect" is essential at initial stages of implementation of the program.

[Early predictor of bronchial suture failure after pneumonectomy]. / Rannii prediktor nesostoyatel'nosti bronkhial'nogo shva posle pnevmonektomii.

OBJECTIVE: To identify the relationship between serum CRP/albumin and bronchial suture failure after pneumonectomy. MATERIAL AND METHODS: A retrospective analysis included 100 patients who underwent pneumonectomy with extended lymph node dissection for lung cancer. Patients were divided into 2 groups depending on postoperative complications: group 1 - bronchial stump failure, group 2 - no similar complications. In all patients, we analyzed markers of inflammation (C-reactive protein and albumin) in preoperative period and after 24 postoperative hours. Bronchial stump failure was found in 20 patients (10 patients (14.7%) after left-sided pneumonectomy and 10 (31%) patients after right-sided pneumonectomy). We found a significant relationship between serum CRP/albumin and bronchial stump failure after pneumonectomy (p<0.05). A prognostic formula was based on the ratio of serum C-reactive protein and albumin: PC = CRP/Alb, where PC - prognostic coefficient, CRP - serum C-reactive protein (mg/l) 24 hours after surgery, Alb - serum albumin (g/l) 24 hours after surgery. PC >2.6 determines high risk of bronchial stump failure after pneumonectomy, PC <2.6 - low risk. Sensitivity of this method is 90%, specificity - 97.5%.

[Robot-assisted linear aortofemoral bypass surgery]. / Robot-assistirovannoe lineinoe podvzdoshno-bedrennoe shuntirovanie.

Aortofemoral bypass surgery is still the «gold standard¼ for aortoiliac lesions with excellent results and long-term patency despite improvement of endovascular surgery. Extensive surgical approaches are accompanied by high risk of postoperative complications. Development of minimally invasive surgery and achievements of computerized technologies made a revolution in all surgeries and minimize trauma following complex reconstructive procedures. This also reduces perioperative risks and accelerates recovery. Computerized robotic systems in vascular surgery provide safe complex procedures on aortoiliac segment. We present robot-assisted linear iliofemoral bypass surgery in a 69-year-old patient with chronic arterial insufficiency Fontein grade IV.

[Different methods of femoropopliteal bypass grafting with autologous vein: propensity score matching analysis]. / Sravnitel'nye rezul'taty razlichnykh metodov bedrenno-podkolennogo shuntirovaniya autologichnoi venoi s primeneniem analiza metodom sopostavleniya otsenok sklonnostei (propensity score matching).

OBJECTIVE: To analyze immediate and long-term results of various methods of femoropopliteal bypass grafting with autologous vein using propensity score matching. MATERIAL AND METHODS: A retrospective single-center open study included 464 patients who underwent femoropopliteal bypass grafting with an autologous vein between January 10, 2016 and December 25, 2019 at the Research Institute - Ochapovsky Regional Clinical Hospital No. 1. The following types of autovenous conduits were used: n=266 - reversed autologous vein (group 1); n=59 - in situ autologous vein (group 2); n=73 - upper limb autologous vein (group 3); n=66 - ex situ autologous vein (group 4). The long-term period was 16.6±10.3 months. RESULTS: We used propensity score matching analysis because patients were not comparable for some indicators. Groups 2-4 included small samples of patients, and their number was reduced to less than 10. This did not allow us to draw reliable conclusions about treatment outcomes. In this situation, we decided to allocate two groups: group 1 - ex situ femoropopliteal bypass grafting; group 2 - other variants of femoropopliteal bypass grafting with autologous vein. Propensity score matching allocated 299 people in group 1 and 46 patients in group 2. There were significant differences in early postoperative incidence of autologous vein thrombosis (group 1: n=3 (6.5%), group 2: n=79 (26.4%), p=0.003; OR= 0.19; 95% CI 0.05-0.64) and postoperative wound suppuration (group 1: n=2 (4.3%), group 2: n=52 (17.4%); p=0.02; OR=0.21; 95% CI 0.05-0.91). In long-term postoperative period, significant differences were obtained in the incidence of limb amputation (group 1: n=6 (13%), group 2: n=85 (28.4%); p=0.02; OR=0.37; 95% CI 0.15-0.92) and myocardial infarction (group 1: n=1 (2.2%), group 2: n=43 (14.4%); p=0.02; OR 0.13; 95% CI 0.01-0.98). CONCLUSION: Femoropopliteal bypass grafting ex situ is characterized by lower incidence of graft thrombosis, amputations of the limb, mild decrease in the incidence of infectious complications and all adverse cardiovascular events in early and late postoperative period compared to conventional surgery (reversed autologous vein, in situ autologous vein, upper limb autologous vein).

[Damage control strategy in surgical treatment of patients with severe gastroduodenal bleeding]. / Primenenie strategii Damage control pri khirurgicheskom lechenii patsientov s tyazhelymi gastroduodenal'nymi krovotecheniyami.

OBJECTIVE/: To objectify patient condition and improve treatment outcomes in patients with benign severe gastroduodenal bleeding. MATERIAL AND METHODS: We analyzed the immediate results of staged surgical treatment of patients with benign severe gastroduodenal bleeding according to the accepted concept of «Damage Control Surgery¼. The Rockall risk scoring system and the Glasgow-Blatchford score (GBS) were used. We preferred two-stage intervention in patients with Rockall score ≥5 and Glasgow-Blatchford score ≥11. RESULTS: Staged approach according to the concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding ensures positive results by minimizing surgical trauma and perioperative bleeding, early stabilization of hemostasis and subsequent successful restoration of digestive function. CONCLUSION: The concept of «Damage Control Surgery¼ in patients with benign severe gastroduodenal bleeding can reduce mortality and incidence of postoperative complications.

[Ultrasound in a differentiated treatment approach for liver diseases]. / Ul'trazvukovoe issledovanie v vybore taktiki lecheniya bol'nykh s zabolevaniyami pecheni.

OBJECTIVE: Prospective assessment of the proposed diagnostic algorithm aimed at increasing the reliability of diagnosis of diffuse and focal liver diseases, reducing diagnostic invasiveness, economic costs, developing management strategy of patients with liver tumors and early diagnosis of hepatocellular carcinoma. MATERIAL AND METHODS: A prospective case-control study included 336 patients with a preliminary diagnosis of diffuse focal liver damage for the period from January 2015 to April 2019. RESULTS: The authors described a diagnostic algorithm for focal liver lesions based on various ultrasound modes including gray-scale scanning (B-mode), Doppler ultrasound and pulse-wave Doppler. Moreover, 2D-SWE for assessing the liver stiffness and fibrosis grade (METAVIR grading system) and CEUS for differential diagnosis of liver neoplasms are applied.

[A multicenter study on the influence of different kinds of carotidal endarterectomy on the course of resistant arterial hypertension]. / Mnogotsentrovoe issledovanie vliyaniya razlichnykh vidov karotidnoi endarterektomii na techenie rezistentnoi arterial'noi gipertenzii.

OBJECTIVE: To analyze the dynamics of systolic blood pressure (SBP) and the results of various types of carotid endarterectomy (CEE) in patients with resistant arterial hypertension (RAH). MATERIALS AND METHODS: The study included 1577 patients with hemodynamically significant stenosis of the internal carotid artery (ICA) and RAH for more than 3 years. Patients were enrolled from January 2014 to December 2020. Depending on the implemented revascularization strategy, 5 groups were formed: group 1 (n=289 (18.3%)) with classical CEE with plasty of the reconstruction zone with a patch, group 2 (n=472 (29.9%)) with eversional CEE with cut-off of carotid glomus (CG); group 3 (n=109 (6.9%)) with the formation of a new bifurcation; group 4: (n=117 (7.4%)) with autoarterial reconstruction; group 5: (n=590 (37.4%)) with glomus-saving CEE. RESULTS: In the postoperative period, no significant differences were obtained in the frequency of deaths (0.34% for group 1; 0.63% for group 2; 0% for groups 3, 4 and 5), myocardial infarction (0.34%, 0.84%, 1.83, 0.85%, 0.33%, respectively); ischemic stroke (0.34%, 1.27%, 0.91%, 0.85%, 0.17%, respectively), hemorrhagic transformation (0%, 0.84%, 0.91%, 0.85%, 0%, respectively). However, according to the frequency of the combined endpoint (death + myocardial infarction + ischemic stroke + hemorrhagic transformation), the lowest rates were observed in the group of classical carotid endarterectomy with plasty of the reconstruction zone with a patch and glomus-sparing CEE (1.03%, 3.6%, 3.67%, 2.56%, 0.5%, respectively). This is due to the absence of cases of labile AH and hypertensive crises among patients of groups 1 and 5, which was ensured by the preservation of carotid glomus (CG). As a result, the number of patients with 2 and 3 degrees of hypertension in these groups decreased statistically significantly. The vast majority of patients after these operations achieved a stable target SBP. In groups 2, 3, and 4, there was a statistically significant increase in the number of patients with 2 and 3 degrees of AH, which is associated with excision of the CG. CONCLUSION: Classical CEE and glomus-sparing CEE techniques make it possible to achieve a stable target SBP level in patients with RAH as a result of CG preservation. Removal or traumatization of the latter during eversional CEE, the formation of a new bifurcation, autoarterial reconstruction is accompanied by the development of labile hypertension, an increase in the degree of hypertension and a high risk of hemorrhagic transformation in the brain. Thus, the most effective and safe types of CEE in the presence of RAH are classical CEE with plasty of the reconstruction zone with a patch and glomus-sparing CEE.

[Stenting of the first segment of the spinal artery in the acutest period of ischemic stroke in the vertebrobasilar territory]. / Stentirovanie pervogo segmenta pozvonochnoi arterii v ostreishem periode ishemicheskogo insul'ta v vertebral'no-bazilyarnoi sisteme.

OBJECTIVE: To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT). MATERIAL AND METHODS: The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis. RESULTS: During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure. CONCLUSION: Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.

[Simultaneous surgery for concomitant lung cancer and diffuse coronary atherosclerosis]. / Simul'tannye operatsii pri rake legkogo i diffuznom koronarnom ateroskleroze.

OBJECTIVE: To evaluate the early outcomes of simultaneous surgeries in patients with concomitant lung cancer and coronary artery disease. MATERIAL AND METHODS: We retrospectively reviewed 37 consecutive patients who underwent CABG with adjunct endarterectomy (n=21) or long segmental coronary artery reconstruction (n=25) and lung resection between 2003 and 2019. Mean age was 61.4±6.7 (range 58-71) years. Males prevailed (n=32, 86.4%). Median sternotomy was used in all patients. Myocardial revascularization was followed by on-pump lung resection. The most common procedure was lobectomy (94.6%) of the right upper lobe (83.7%). Lymph node dissection was performed in all patients. RESULTS: CPB time was 162±19.3 min, aortic cross-clamping time 71±14.2 min. There was no in-hospital mortality. Incidence of perioperative myocardial infarction was 5.4%. Postoperative complications were atrial fibrillation (n=6, 16.6%), re-exploration for bleeding (n=1, 2.7%), pneumonia (n=2, 5.4%). Mean hospital-stay was 14.4 days (range 11-21). CONCLUSION: Simultaneous lung resections and coronary artery reconstruction is a safe and reliable surgical method in patients with diffuse coronary atherosclerosis and lung cancer. The developed system of choice, evaluation and surgical treatment of patients with concomitant cardiopulmonary pathology is fundamental for successful treatment of these difficult patients. We need larger randomized studies for certainty.

[Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures]. / Blizhaishie rezul'taty pankreatoduodenal'noi rezektsii posle razlichnykh variantov rekonstruktsii pishchevaritel'noi sistemy.

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.

[Comparison of transpedicular endoscopic sequestrectomy and discectomy in the treatment of lumbar intervertebral disc herniation with a high degree of migration]. / Sravnitel'naya otsenka effektivnosti transpedikulyarnoi endoskopicheskoi sekvestrektomii i mikrodiskektomii v lechenii mezhpozvonkovykh gryzh poyasnichnogo otdela s vysokoi stepen'yu migratsii.

BACKGROUND: Surgical treatment of intervertebral disc herniation with a high degree of migration (beyond the vertebral pedicle) is a difficult problem without an unambiguous solution. In this manuscript, we compare the effectiveness of transpedicular endoscopy and standard discectomy in the treatment of patients with this disease. OBJECTIVE: To compare transpedicular endoscopic sequestrectomy and discectomy in the treatment of lumbar intervertebral disc herniation with a high degree of migration. MATERIAL AND METHODS: There were 28 patients divided into 2 groups: group 1 - 13 patients after transpedicular endoscopic sequestrectomy, group 2 - 15 patients after discectomy. RESULTS: Transpedicular endoscopic sequestrectomy ensured significantly better intraoperative parameters (incision length, blood loss, surgery time) (p<0.01). In both groups, postoperative VAS score of leg pain was significantly reduced within a day after surgery from 7.4±1.3 to 0.7±0.7 and from 7.1±1 to 0.8±0.5, respectively. In the 1st group, VAS score of back pain regressed from 5.2±0.7 to 1.1±0.89 by the end of the 1st postoperative day. This value was 0.6±0.5 a year later. In the 2nd group, VAS score of back pain regressed from 4.9±1 to 2.5±0.9 by the end of the 1st postoperative day. This value was 2.8±2.3 a year later. According to McNab clinical outcome scale, excellent and good results after transpedicular endoscopic sequestrectomy were obtained in all 13 (100%) patients, after discectomy - in 80% of cases. CONCLUSION: Transpedicular endoscopic sequestrectomy is optimal for intervertebral disc herniation with a high degree of migration due to fast postoperative recovery and no complications.

[Frozen elephant trunk procedure for DeBakey type i acute aortic dissection complicated by lower limb malperfusion]. / Ostroe rassloenie aorty I tipa (po Debeiki) s sindromom mal'perfuzii nizhnikh konechnostei.

Two-stage surgical treatment of a patient with type I acute aortic dissection and lower limb malperfusion is reported in the manuscript. Frozen elephant trunk procedure was applied. A 49-year-old man was hospitalized with a diagnosis of «Debakey type I acute aortic dissection¼ in 7 hours after manifestation of the disease. At admission, paleness and numbness of both lower limbs with a violation of active movements were observed in addition to pain syndrome. Chest CT revealed false lumen thrombosis within the distal aorta followed by stenosis of aortic bifurcation up to 80% and stenosis of the right common iliac artery up to 80%. Considering critical lower limb ischemia, axillo-bifemoral bypass surgery was performed at the first stage. A day later, the patient underwent replacement of ascending aorta, aortic arch and descending thoracic aorta. E-vita Open Plus № 24 hybrid prosthesis and frozen elephant trunk procedure under hypothermia 25o C with bilateral antegrade cerebral perfusion were used. CPB time was 285 min, aortic cross-clamping time - 180 min, circulatory arrest - 135 min. Postoperative period was uneventful, ICU-stay - 5 days. The patient was discharged after 20 days. Control CT confirmed false lumen thrombosis throughout the stent-graft. Follow-up survey after 1 year revealed no complaints.

[Transsternal occlusion of main bronchi fistulae after pneumonectomy]. / Transsternal'naya okklyuziya svishcha glavnogo bronkha posle pnevmonektomii.

OBJECTIVE: To summarize our experience in transsternal occlusion of main bronchus fistula. MATERIAL AND METHODS: We have performed 146 transsternal occlusions of the main bronchi for the period from 1979 to 2018. There were 123 (84.2%) men and 23 (15.7%) women. Mean age of patients was 63 years. Lung tuberculosis was diagnosed in 36 (24.7%) patients, lung cancer - 91 (62.3%) patients, non-specific suppurative lung diseases - 14 (9.6%) patients, trauma - 5 (3.4%) patients. All patients underwent transsternal occlusion of the main bronchi fistulae with or without pericardial cavity dissection. Wedge-shaped bronchial resection or tracheal bifurcation resection were carried out for a short stump fistula. RESULTS: Perioperative complications occurred in 28 (19.2%) out of 146 patients. Intraoperative complications developed in 4 (2.6%) patients. Postoperative complications were observed in 25 (17.1%) patients. Intraoperative mortality rate was 1.4% (n=2), postoperative mortality - 6.2% (n=9). Thus, overall mortality rate was 7.6% (n=11 It should be noted that intraoperative complications were absent if dissection of the pericardium and pulmonary artery stump ligation were not performed. CONCLUSION: Transsternal occlusion of the main bronchi fistulae was successful in 80.8% of patients. In these cases, healing of fistulae was not associated with any complications. Thus, we believe that transsternal occlusion of the main bronchial stump fistula should be considered as preferable surgical strategy.

[Complete detachment of the right coronary artery in a patient with acute aortic dissection type A]. / Polnyi otryv pravoi koronarnoi arterii u patsienta s ostrym rassloeniem aorty (tip A).

Extremely rare and formidable complication of acute aortic dissection type A in a young patient is reported in the article. Clinical symptoms and features of surgical technique are described.

[Results of anterior abdominal wall repair with mesh implants in patients with postoperative ventral hernia]. / Rezul'taty vosstanovleniia perednei briushnoi stenki pri posleoperatsionnykh ventral'nykh gryzhakh s ispol'zovaniem setchatykh implantatov.

AIM: To analyze the results of the restoration of the anterior abdominal wall in postoperative ventral hernias using mesh implants. MATERIAL AND METHODS: The study was of 680 patients, who underwent abdominal wall reconstruction using mesh implants. RESULTS: A total of 105 postoperative complications (15.44%) in 84 (12.35%) patients; the postoperative period was without complications in 596 (87.65%) patients. The greatest number of complications was noted after laparoscopic IPOM - 13 patients (20.31%); the smallest - after posterior component separation - 24 (7.5%). Also described 10 systemic complications: 8 of which were stopped by conservative therapy, in 2 cases repeated surgical intervention was required with a change in the type of wall reconstruction. Statistical analysis did not show statistically significant differences in the incidence of complications between the different versions of the performance of hernioplasty, except for the posterior muscular plastics. Statistical analysis also showed a link between the likelihood of various complications and the type of ventral hernia repair. CONCLUSION: Conducting different methods abdominal wall reconstruction using mesh implants is techniques with a low level of postoperative complications and comparable results when performing various types of plastics.

[Surgical treatment of extensive posttracheostomy tracheal stenosis using a new technique]. / Lechenie rasprostranennogo stenoza trakhei s primeneniem novoi metodiki.

We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.

[Minimally invasive thoracoscopic and robot-assisted lobectomy]. / Miniinvazivnye videotorakoskopicheskie i robot-assistirovannye lobéktomii.

OBJECTIVE: To compare the early outcomes of video-assisted and robot-assisted lobectomy. MATERIAL AND METHODS: There were 74 robot-assisted lung resections for the period 2017-2018. Sixty-six patients underwent lobectomy and 8 - segmentectomy. Patients were divided into 2 groups to compare thoracoscopic procedures. The main group consisted of 66 patients after robot-assisted lobectomy. The control group included 247 patients after video-assisted lobectomy. Mean age of patients was 60.5 years (range 35-70). There 72% men and 28% women. CONCLUSION: Both thoracoscopic procedures are characterized by high efficiency and safety. However, certain disadvantages are peculiar to both methods.

[Specific Features of the Course of Acute Coronary Syndrome in Patients with Newly Developed Atrial Fibrillation in Clinical Practice According to the Data of the Register of Acute Coronary Syndrome].

AIM: to elucidate risk factors of development of atrial fibrillation (AF) in patients with acute coronary syndrome (ACS), and to assess of patient's adherence to oral anticoagulant therapy (OAT) during 12 months after ACS episode according to the data of the Total ACS Registry for the Krasnodar Territory. MATERIALS AND METHODS: In this retrospective analysis we used Registry data on patients with ACS and concomitant AF, consecutively admitted to cardiological departments of the S.V. Ochapovsky Territorial Clinical Hospital from 20/11/2015 to 20/02/18. Number of patients in the analyzed group was 201 (52 with AF which first appeared in connection with the index ACS). Survivors after hospital discharge were contacted by telephone and at planned visits. The analysis included assessment of rates of the following outcomes: inhospital death, hemorrhagic and thromboembolic complications, prognostic efficacy of the CRISADE and HAS BLED scores, and expediency of prescription to patients with ACS and concomitant first AF episode of prolonged OAT after hospital discharge. RESULTS: Demographic and anamnestic data of patients with the first AF attack at the background of ACS were like those of patients with other types of AF. This group of patients was characterized by more severe course of the disease, but this produced no impact on inhospital mortality and rate of complications, as well as on mortality for 12 months after hospital discharge. CONCLUSION: The results of this analysis are important for understanding distinctive characteristics of patients with AF first developed during ACS.