Objective. Comparative effectiveness assessment of laparoscopic and open interventions for purulent-inflammatory diseases of abdominal organs in children. Material and methods. Treatment results of 838 patients (2017—2024) were analyzed: 706 (84.3%) underwent laparoscopic surgery, 132 (15.7%) — open surgery. Immediate results, complications according to Clavien—Dindo classification, quality of life (PedsQL 4.0), and long-term outcomes were evaluated. Stratified analysis by disease stage was performed to correct for intergroup differences. Results. Complication rate for laparoscopy was 4.2% versus 13.6% for open operations (p<0.001). Severe complications (≥IIIb) — 0.1% versus 2.3% (p=0.003). Hospital stay decreased from 6.7±2.8 to 3.2±1.4 days. In the long-term period, postoperative hernias were absent in the laparoscopy group versus 7.1% after open interventions. Quality of life was significantly higher after minimally invasive operations (94.2±5.1 versus 87.5±8.3 points). Conclusion. Laparoscopic interventions provide reduced complications, accelerated rehabilitation, and better long-term results for most forms of purulent-inflammatory diseases in children.

Background. Abdominal pseudohernia is a rare disease that manifests itself as a protrusion of the abdominal wall, visually resembling a true hernia, but without an accompanying fascial or muscular defect. Given the variety of possible causes that trigger the pathogenesis of the disease, approaches to its treatment and the timing of surgical intervention should be determined strictly individually, taking into account the etiology and clinical picture of the pseudohernia. The available literature contains isolated works demonstrating individual clinical observations without a systemic analysis and generalized surgical treatment tactics. Objective. The purpose of the work: to study the current state of the problem and present our own experience in treating pseudohernia of the abdominal wall that developed after the lipoaspiration procedure. Material and methods. An analysis of the literature and clinical observations published in the period from 2021 to 2024 on the problem of diagnosis and treatment of pseudohernias of the abdominal wall in the Pubmed, Google and e-library databases was carried out. Our own experience of hybrid surgical treatment of a patient with a pseudohernia is presented. Results. It is important to search for the cause of abdominal wall muscle atrophy in patients with pseudohernia, since the course of the disease is reversible in the case of non-mechanical genesis of innervation disorder. In this case, conservative treatment of the underlying disease is indicated. Diagnosis of abdominal wall pseudohernia should include computed tomography or magnetic resonance imaging, which will allow differential diagnosis with a true hernia, as well as planning surgical intervention in case of irreversible denervation of the abdominal wall muscles. Within 6 months to 1 year after traumatic nerve injury, partial or complete compensatory reinnervation (the so-called sprouting) of the denervated region is possible. In this regard, the decision on surgical treatment of pseudohernia should be made by a multidisciplinary team of doctors (including a neurologist, neurosurgeon, plastic surgeon) no earlier than a year after denervation. Conclusion. The combination of laparoscopic and open access to the pseudohernia area allows for precise determination of the suturing boundaries and optimal aesthetic effect. However, isolated extended transabdominal preperitoneal laparoscopic access is possible. Laparoscopic transabdominal preperitoneal access, along with hybrid access, allows for precise determination of the muscle atrophy area boundaries and optimal suturing of this zone. The use of a large mesh implant is advisable for creating an abdominal wall frame and preventing further thinning of the formed scar.

Objective. Improving treatment outcomes of patients with neuromuscular diseases of the esophagus (NMDE). Material and methods. 159 operations performed at NMDE: 152 patients had achalasia of the esophagus (AE), 4 had diffuse esophageal spasm (DES), and 3 had achalasia of the upper esophageal sphincter. The third stage of achalasia was observed in 113 (74.3%) patients, the fourth — in 39 (25.7%). Results. All surgical interventions for AE performed using a laparoscopic approach, esophagocardiomyotomy was supplemented by Dor fundoplication. DES performed a thoracoscopic access — an extramucous esophagomyotomy (Biokka operation). Pharyngeal achalasia was performed by cervicotomy. Duration of the operation was 107±35.6 minutes; the average hospitality day was 4.2. With AE, 16 patients (10.5%) had mucosal damage, 6 patients underwent conversions (3.9%), 10 patients (6.6%) had defects sutured videoendoscopically. In the postoperative period, 1 patient (0.7%) developed an esophageal fistula closed by vacuum therapy. The long—term treatment results of 130 (85.5%) patients with AP who underwent endovideosurgery were studied: transient dysphagia was noted in 2 patients (1.5%), heartburn — 4 (3.1%), recurrence of the disease requiring surgery — 1 (0.7%). Conclusions. In the case of NMDE, endovideosurgery operations should be performed according to strict indications and contraindications. Providing individual access, considering the patient’s body type, anatomical features, the nature and localization of the pathological process, reduces the number of intraoperative complications, the occurrence of which is not always an indication for conversion.

Background. Intraoperative photodynamic therapy (IPDT) is considered a promising approach to the combined treatment of patients with malignant intrathoracic tumors. However, compliance with the treatment protocol remains a concern for specialists. These concerns are primarily related to dosimetry issues on geometrically complex surfaces using special diffusers. Objective. Evaluation of the effectiveness of endoscopic and intrapleural IFDT in the complex treatment of malignant tumors of intrathoracic localization based on a series of our own clinical observations. Material and methods. From 2017 to 2023, intrapleural photodynamic therapy (IPDT) was performed on 18 patients (6 men and 12 women) with pleural carcinomatosis of various etiologies at the Sokolov North-Western District Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia and the Saint-Petersburg State Phthisiopulmonology Research Institute. All patients underwent video-assisted thoracoscopic pleurectomy, followed by an intrapleural IPDT session. Endobronchial photodynamic therapy (EPDT) was performed on seven patients with lung cancer with signs of obstructive atelectasis due to tumor spread and one patient with central squamous cell carcinoma in situ of the left lower lobe bronchus. Results. Following pleurectomy supplemented with intravascular photodynamic therapy (IPDT), all patients demonstrated a positive clinical effect, stopping fluid accumulation in the pleural cavity. In all cases, EPDT resulted in resolution of obstructive atelectasis due to a reduction in the endobronchial tumor component. A patient with squamous cell carcinoma in situ of the left lower lobe bronchus demonstrated complete tumor regression. Conclusion. IFDT improves the outcomes of comprehensive treatment for patients with malignant pleural lesions of various etiologies, effectively reducing the incidence of complications such as recurrent hydrothorax. However, the lack of a standard protocol for the procedure makes it difficult to reproducibly and non-systematically utilized. The lack of accessible intracavitary navigation and dosimetry systems further complicates the procedure and the evaluation of its effectiveness.

Background. Rare forms of acute appendicitis are known to be difficult to diagnose and treat, include the infringement of the appendix in case of Amyand hernia (in the hernial gate of the inguinal hernia). The literature has not proposed an up-to-date treatment algorithm for this disease. Objective. The goal of this study was to develop the features and opportunities of the algorithm for Amyand hernia with acute appendicitis. Material and methods. This paper presents the features of the course, diagnosis, and surgical treatment of an Amyand hernia with acute appendicitis. The paper also presents an analysis of a clinical case of acute appendicitis with an Amyand hernia and one of the options for a tactical solution to this situation in accordance with the standards of modern surgery. Results. In our clinical case, we divided the surgical treatment into two stages. At the first stage, we resorted to laparoscopic appendectomy, but refrained from simultaneous alloplasty in favor of simple suturing of the hernial gate (local autoplasty) from laparoscopic access, followed by delayed full-fledged alloplasty with a mesh prosthesis at the second stage of surgical treatment. This choice was associated with the presence of destructive perforating changes in the appendix and a high level of local contamination during the primary surgery. Conclusion. The postoperative period proceeded smoothly after both the first and second stages of surgical treatment. We have not encountered any complications and can recommend this treatment algorithm.

Objective. Analysis of the results of using fundoplication in metabolic and bariatric surgery and classification of indications for its use. Material and methods. Within the framework of this study, a search for English-language articles was performed in the PubMed and Cochrane Library databases. The following search terms were used: «fundoplication», «bariatric», and then the words «gastric bypass», «sleeve gastrectomy», «combination», «plication» was added one by one. 503 publications were found in the databases, of which 49 sources were ultimately selected as corresponding to the objectives of the systematic review. The results of using a combination of fundoplication in bariatric and metabolic surgery were studied. Results. As a result of the analysis of scientific papers, the authors classified the indications for the combined use of fundoplication in metabolic and bariatric surgery. The types of combined use of laparoscopic sleeve gastrectomy with fundoplication are defined, and a classification of the combination of gastric bypass and fundoplication is described. The work indicates the place of Roux-en-Y gastric bypass and fundoplication in revision bariatric surgery. One anastomotic gastric bypass using the fundus of the excluded stomach and the results of using the FundoRing method are separately described. Conclusions. Thus, the analysis of the results of the combined use of fundoplication in metabolic and bariatric surgery indicates the following provisions.First, the possibility and necessity of classifying the combined use of fundoplication in various bariatric surgical methods. Secondly, the trend of using fundoplication not only for the treatment of preoperative GERD and prevention of postoperative reflux esophagitis, but also to improve the reliability of stapler sutures on the gastric pouch and to treat dumping syndrome, as well as to reduce the likelihood of weight regain of obesity after bariatric interventions.

Background. Barsony—Teschendorf syndrome is characterized by the presence of segmental non-propulsive contractile waves occurring simultaneously at different levels regardless of the pharynx, which is a key factor in the development of esophageal diverticula. Epiphrenic diverticulum is a rare disease, which accounts for about 0.015% of esophageal diseases. For a long period of time, surgical treatment of patients with esophageal diverticula implied open diverticulectomy or laparo-thoracoscopic diverticulectomy. However, it should be noted that these interventions are characterized by a relatively high level of postoperative complications and a significant mortality rate. Over the past decade, in the clinical practice of leading surgical clinics, intraluminal endoscopic intervention — endoscopic peroral esophagocardiomyotomy — has increasingly been considered as the operation of choice for esophageal diverticula. Clinical case. A 73-year-old patient was treated at the Vishnevsky National Research Medical Center for diffuse esophagospasm and epiphrenal diverticula of the esophagus. Results. In our clinical observation, we obtained a convincing clinical result in the treatment of a patient with Barsony-Teschendorf syndrome and epiphrenic diverticula. The performed extended endoscopic peroral esophagocardiomyotomy allowed not only to get rid of the disease, which is difficult to treat surgically, but also to radically improve the quality of life. Conclusion. The intraluminal endoscopic approach to the treatment of patients with epiphrenic diverticula of the esophagus is an optimal, modern technique and a preferable alternative to traditional surgical diverticulectomy, since it is a pathogenetically significant method that improves the function of the esophagus in neuromuscular disease. The key to the success of endoscopic peroral esophagocardiomyotomy in achieving high efficiency and low recurrence is an extended myotomy of the esophagus.

In addition to its recognized efficacy, endoscopic band ligation (EBL) of esophageal varices can lead to a number of complications, among which post-banding ulcer bleeding (PUB) has a special place. Model of end-stage liver disease >18 index in combination with emergency EBL has been found to be the most likely predictor of PUB. The choice of effective endoscopic treatment for gastric variceal (GV) is often reduced to endoscopic interventional techniques. Here, the choice of intervention under the control of endoscopic ultrasound scanning (EUS) has shown its superiority over traditional endoscopic and X-ray endovascular methods of treating. Standard EBL and endoscopic sclerotherapy (ES) have a higher complication rate in the treatment of gastrointestinal ectopic varices (GEV). Bypass surgeries do not always achieve eradication or regression of GEV. The use of EUS allows delineation of afferent vessels for direct injection of sclerosant, which is not feasible with conventional endoscopic treatment. The main causes of non-variceal portal bleeding are portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). New minimally invasive diagnostic methods allow to differentiate PGH and GAVE with high specificity, and can help in understanding the etiopathogenesis of GAVE and finding effective ways of its treatment.

Background. Bariatric surgery is an effective long-term treatment for obesity and associated metabolic disorders such as type 2 diabetes mellitus (DM), hypertension, dyslipidemia, and sleep apnea. Despite the fact that the safety and effectiveness of bariatric interventions has now been proven, like any other surgical intervention, it’s associated with complications. Objective. To assess the incidence of early complications and 10-day mortality in patients undergoing bariatric surgery in the Russian Federation. Material and methods. Information on the frequency of interventions performed, associated complications and mortality was obtained from the Russian National Bariatric Registry database, containing anonymized data of patients who underwent bariatric intervention in the period from 03/03/2004 to 04/12/2023. The analysis included patients aged 18—70 years who underwent primary surgery. In addition to assessing 10-day mortality rates and the frequency of early postoperative complications, a comparative analysis of the likelihood of developing complications depending on the class of obesity, the patient’s age and the presence of comorbid conditions was carried out. Results. The analysis included 33.627 patients. The 10-day postoperative mortality rate was 0.098%. The rate of early postoperative complications was 1.77% for all types of operations and groups of patients. Bleeding and leakage were the most common: up to 1.2% and 1.5%, respectively, depending on the type of operation. The frequency of their development was statistically significantly influenced by the patient’s age, gender, BMI and the presence of concomitant pathology. Conclusion. Minimal postoperative risks of complications were observed in patients after sleeve gastrectomy. The proportion of bleeding cases in this group did not exceed 0.8%, and the failure of the stapler line did not exceed 0.5%. The 10-day postoperative mortality rate after sleeve gastrectomy was 0.05%.

Objective. Comparative evaluation of the duration of training and immediate results of treatment with videothoracoscopic (VATS) lobectomy via two-port access and open lobectomy in novice surgeons. Material and methods. The study included 118 surgical interventions performed in the thoracic department of AU RKOD of the Ministry of Health of the Chuvash Republic from January 2021 to February 2023. For comparative evaluation of the two learning curves, the operations were divided into two groups: the first group included VATS lobectomies performed via two-port access by a surgeon with initial zero experience in performing such operations (n=50) but with more than 5 years of experience in thoracic oncology; the second group included surgical interventions (n=68) performed by surgeons with less than 5 years of experience in thoracic surgery. Results. Evaluation of the learning curves showed that 31 operations were required to master VATS and 29 for open lobectomies, after which the duration of operations did not change significantly. The duration of surgery was longer in the VATS group (190 (150—230) min vs. 150 (122.5—175) min; p=0.0004). Blood loss was not statistically different in both groups (VATS 100 (50—200) ml, open lobectomy 75 (50—100) ml; p=0.42). The duration of drainage was shorter in the VATS group (6 (4—7) days vs. 7 (6—8) days; p=0.0000). The number of removed lymph nodes was higher in the thoracoscopic lobectomy group (11.5 (8.5—16) vs. 8.5 (7—12.5); p=0.01). Conclusion. The learning curves for VATS lobectomy and thoracotomy lobectomy are comparable. The level of competence and safety for performing standard lobectomies is achieved on average for both techniques after 30 operative procedures. However, significantly more operations are required to achieve mastery and to perform combined lobectomies.