[Strategy of surgical treatment of strangulated inguinal hernias in elderly and senile age.]

We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.

[Injuries of the duodenum].

Based on an experience with treatment of 68 patients with injuries of the duodenum the authors have developed a diagnostic algorithm always permitting the diagnosis of injuries of the retroperitoneal part of the duodenum. A classification of severity of the duodenal injury was proposed determining the volume and type of surgery. Using the proposed therapeutic-diagnostic program decreased postoperative lethality from 52.4% to 11.8% in patients with wounds and from 60% to 13.4% in patients with closed injury of the duodenum.

[The diagnosis and treatment of wounds to the lumbar area].

An analysis of results of treatment of 228 patients with wounds of the lumbar region has shown that in 66.2% of cases they were not penetrating, in 33.8% they were penetrating. In 42 patients there were injuries of internal organs and of the vessels of the abdominal cavity and retroperitoneal space. The casualties must be examined under conditions of the emergency operating room and which in addition to thorough revision of the wound must include subsidiary methods of examination: USI, survey radiography of the thoracic and abdominal cavities and diagnostic survey laparoscopy, if necessary.

[Acute gastrointestinal bleedings of tumorous etiology].

A retrospective analysis of treatment of 436 patients with acute bleedings from tumors of the gastrointestinal tract was made. Elderly and senile patients made up 72% of the hospitalized patients. The emergency complex diagnostics in 75% of the patients under conditions of a multi-profile hospital allowed the source of bleeding to be detected during the first day, the strategy of treatment being also determined. Radical operations could be fulfilled both in emergency and planned order on most patients. Lethality of patients with tumors of the stomach and colon after radical operations was 10%, after palliative operations 29.5% and 27.9% respectively. Acute bleedings from tumors of the gastrointestinal tract is not the absolute sign of the patient being inoperable.

[Diagnosis and treatment of wounds of the gluteal area].

The authors present results of surgical treatment of 98 patients with gluteal wounds. In 93.9% of cases the wounds were not penetrating and in 6.1% there were penetrating wounds. All the patients admitted to hospitals in state of shock as well as suspected to the penetrating character of the wound underwent general laparoscopy. In 2 patients with penetrating wounds of the abdominal cavity and in 7 patients with non-penetrating wounds ligation of the internal iliac artery was necessary because of huge bleeding. Two patients (2%) with penetrating wounds of the abdominal cavity died.

[Specific features of surgical strategy in gastroduodenal ulcer bleedings in elderly and senile patients].

An analysis of results of surgical treatment of 107 elderly and senile patients with gastroduodenal ulcer bleedings was made. Emergency operations were fulfilled on 47 patients, urgent operations on 56 patients and planned operations--on 4 patients. Ulcers of large size prevailed. Most of the patients had complications of ulcer disease. Palliative interventions were performed on 27 patients: suturing the vessel--in 20, ablation of the ulcer--in 7. Lethality was 33.3%. Radical operations were performed on 80 patients: resection of the stomach--in 75, vagotomy--in 5. Lethality was 16.3%.

[Specific topographic-anatomical and technical features of resection of the stomach by the Roux method].

The topographic-anatomical investigations of the extraorganic part of the arterial and nervous systems of the duodenum and the initial part of the jejunum in combination with the results of the clinical use of gastric resection by the Roux method allowed to draw a conclusion that the development of Roux syndrome can be prevented by a transection of the jejunum with the saved arcades between the first jejunal artery, the duodenal branch and the second jejunal arteries. The rules of gastric resection by the Roux method and indications to this procedures in patients with ulcer disease of the stomach and duodenum are described. Good and excellent long-term results were obtained in 75.8% of the patients operated upon.

[Associated post-gastric resection syndromes]. / Sochetannye postgastrorezektsionnye sindromy.

In the clinic there were 545 patients treated for postgastroresectional syndromes, 289 (53%) of them had associated postgastroresectional syndromes. A mild degree of clinical manifestations of the associated syndromes was found in 11%; medium degree in 35% and severe--in 54% of the patients. An individualized approach to the decision for methods of reconstructive operations was substantiated which allowed to get positive results in 95% of the patients. Postoperative lethality was 1.8%.

[Experience in treating patients with postvagotomy syndromes]. / Opyt lecheniia bol'nykh s postvagotomicheskimi sindromami.

The article generalizes experiences with treatment of 257 patients with postvagotomy syndromes (PVS). The patients were distributed according to the character of the syndromes. Main causes of the development of PVS are discussed. The authors describe the specific methods of diagnosis allowing individualized approach to option of the program of treatment. Criteria of decision in favor of various methods of reconstructive-restorative procedures are proposed. The individualized approach to treatment allowed to get considerably better condition in 95% of patients with PVS.

[Long-term results of pylorus-preserving gastric resections]. / Otdalënnye rezul'taty pilorosokhraniaiushchikh rezektsii zheludka.

An analysis of long-term results of pylorus-preserving resections of the stomach performed on 540 patients has shown that 44 patients (8.1%) had different postgastroresectional syndromes. Operations were made on 20 patients with severe manifestations of the postgastroresectional syndromes. An analysis of the causes of complications was made as well as the substantiation of the methods of reconstructive interventions. Indications and contraindications for pylorus-preserving resections of the stomach are proposed.

[The diagnosis and treatment of injuries of the upper respiratory tract in wounds and traumas of the neck]. / Diagnostika i lechenie povrezhdenii verkhnikh dykhatel'nykh putei pri raneniiakh i travmakh shei.

The authors made an analysis of results of treatment of 339 patients with wounds and closed injuries of the neck. Laryngotracheal injuries were found in 27 (7.9%) patients, in 15 patients the injuries being of combined character. Active surgical strategy including the necessary thorough revision of the penetrating wounds of the neck during operation under general narcosis anesthesia, by instrumental methods of examination. Such strategy allowed timely detection and adequate elimination of injuries of the organs and vessels of the neck and improvement of the results of treatment of such patients.

[Acute ulcers of the gastrointestinal tract complicated by hemorrhage and perforation]. / Ostrye iazvy zheludochno-kishechnogo trakta oslozhennye krovotecheniem i perforatsiei.

The data on 130 patients with acute ulcers of the gastrointestinal tract complicated hemorrhage and perforation are reported. Acute ulcers developed in patients with cardiovascular diseases (47%), intoxication (17.7%), postoperative paresis of the stomach and intestine (10%), other pathology (15.3%), and in medication (10%). The former manifested in acute hemorrhage in 108 patients, perforation--in 8, hemorrhage and perforation--in 14. In 86% of cases ulcers were located in the stomach, and in 63%--these were multiple. Conservative therapy was employed in 97 patients and 33 patients were operated upon. The mortality after early operations was 2.5 times as low as in the expectation policy and conservative therapy.

[The individualized choice of the method of operation in the planned surgery of gastric and duodenal peptic ulcers]. / Individualizirovannyi vybor sposoba operatsii v planovoi khirurgii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

A working classification of gastroduodenal ulcers was developed by the authors on the basis of surgical treatment of 1838 patients with ulcer disease of the stomach and duodenum. When used in combination with the complex examination of the patients it allows to individually choose the operative method. The indications and contraindications for different kinds of surgery are given. Specific features of the postoperative management are described.

[Treatment of patients with postgastrectomy syndromes]. / Lechenie bol'nykh s postgastrorezektsionnymi sindromami.

An experience with treatment of 545 patients with organic, functional and combined postgastroresectional syndromes (PGRS) is analyzed. The patients are divided into groups depending on the character of the syndromes and their combinations. The most frequent causes of the development of PGRS are formulated. Special methods of preoperative examination and preparing are described which allow individual approach to choice of the method of reconstructive-restorative operations. Some technical details of the reconstructive interventions are described. In 95% of the patients operated upon long-term results of treatment were good and satisfactory.

[Radioisotope method of diagnosis of internal hemorrhage]. / Radioizotopnyi sposob diagnostiki vnutrennego krovotecheniia

The authors have developed experimentally and employed clinically a new method of diagnosing a localization of the source of intermittent internal hemorrhage. The method consists in determination of blood congestion sites by radioactive changes measured by external recordings after injection of 2.5 muc per Kg weight of radioactive chromium-51 in sodium chromate in the circulating blood.

[Acute tumorous obstruction of the colon in elderly and senile patients]. / Ostraia opukholevaia neprokhodimost' obodochnoi kishki u bol'nykh pozhilogo i starcheskogo vozrasta.

The authors present the results of surgical treatment of 106 elderly and senile patients. In 30 patients admitted in a extremely severe condition the acute intestinal obstruction was combined with peritonitis. Postoperative mortality in this group of patients was 86.7% in spite of intensive treatment. In 28 patients generalization of the process was detected and they were given palliative interventions for liquidation of acute intestinal obstruction. Postoperative mortality in this group was 39.2%. Conventional radical operations were fulfilled on 48 patients. Postoperative mortality in this group was 20.8%. Later on the intestinal patency was reestablished in 15 patients. The data obtained show the possibility to widen the indications to radical operative interventions and to improve results of treatment of such patients.

[Surgical strategy for wounds of the cervical part of the esophagus]. / Khirurgicheskaia taktika pri raneniiakh sheinogo otdela pishchevoda.

An analysis of results of treatment of 425 patients aged from 15 to 85 years with penetrating wounds of the neck was made. In 40 (8.1%) patients there were wounds of the cervical part of the esophagus, 29 of them had associated injuries. The proposed active surgical strategy consisted in a necessary thorough revision of the penetrating wounds of the neck using general anesthesia and then directly in the operation room using subsidiary methods of examination such as urgent x-ray analysis with a water-soluble contrast, esophagoscopy, larengotracheoscopy. This approach allowed detection of injuries of the cervical part of the esophagus, even in cases of the absence of clinical symptoms of esophagus injuries. In all the patients the wounds of the esophagus were sutured and followed by active aspiration drainage and antibacterial treatment with modern antimicrobial medicines.