[Consequences of the COVID-19 pandemic for surgical service]

The COVID-19 pandemic has a serious impact on surgical service, emergency and especially elective surgical care. Many hospitals were re-designated as COVID hospitals due to resource constraints and large number of COVID-19 patients requiring hospitalization. This led to cancellation or postponement of scheduled surgeries. In addition, restrictions in elective surgery were associated with the risk of infection in surgical patients. Various protocols and guidelines recommended non-surgical or outpatient treatment if possible. During the pandemic, postoperative morbidity and mortality in emergency surgery increased significantly. The same is true for elective surgeries in 7-8 weeks after previous coronavirus infection. The authors analyze the issues of organization, priorities for restoration of elective surgery and criteria for patient selection.

[Open and laparoscopic surgery via minimally invasive approach in the treatment of perforated ulcer: a systematic review and metaanalysis]

OBJECTIVE

Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer.

MATERIAL AND METHODS

Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis.

RESULTS

We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503).

CONCLUSION

A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.

[Drug treatment of coronavirus disease COVID-19: evidence exists?]

The article provides a review of foreign literature for 2020 on existing methods of drug treatment of coronavirus disease COVID-19. To date, in the treatment of COVID-19 in different countries, a little more than 10 drugs are used. The largest number of studies on the testing of these drugs is carried out by scientists from China, the USA, and European countries. It should be noted that among these drugs there is not a single new drug developed specifically for the treatment of COVID-19, the recommended and used drugs have previously been used to treat, as a rule, diseases of the viral etiology, less often another pathology. These suggestions are often based on analogy, the hypothesis of their supposed effectiveness for COVID-19. It can be assumed that a brake on the development of a drug specific for coronavirus disease is a poor knowledge of the pathogenesis of virus invasion in the body's adhesives and the development of complications. The review provides detailed literature data on drugs such as hydroxychloroquine / chloroquine, lopinavir/natinavir, remdesivir, ACE inhibitors and angiotensin converting enzyme receptor blockers, tissue plasminogen activator, as well as plasma transfusion transfusions.

THE RUSSIAN ASSOCIATION OF COLOPROCTOLOGY CLINICAL GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF HEMORRHOIDS

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[Classification of surgical complications]

AIM

To develop classification of surgical complications.

MATERIAL AND METHODS

The most common and recently proposed classifications of surgical complications (Clavien-Dindo, Occordion, R. Satava, et al., A. Kazaryan, et al.) were analyzed. Postoperative complications in 25 556 patients were retrospectively assessed. Incidence and severity of complications, methods of their correction, effect of complications on length of hospital-stay were analyzed.

RESULTS

As a result of comprehensive analysis, new classification of surgical complications was proposed. 5 grades of complications were identified. Classification is based on anatomical features, type of complications (within surgical access, organ or cavity), correction depending on this type, severity of complications. Causal relationship of complication with type of repair and increased length of hospital-stay was considered.

CONCLUSION

Classification proposed is anatomically justified, considers causal relationship of complications and their repair, as well as length of hospital-stay.

PROVISION OF SURGICAL SAFETY

OBJECTIVE. The research assessed the efficacy of WHO checklist for prevention of avoidable complications in surgery. MATERIALS AND METHODS. The article presents the results of implementation of WHO recommendations (checklist of measures) for prevention of so-called avoidable complications in surgery during performance of 35300 operations in 3-year period. The authors included two additional issues in the checklist about prevention of thromboembolic complications and temperature control in the operating unit. RESULTS. The number of preventable complications decreased in clinic after the implementation of WHO recommendations. The rate of thromboembolic and different postoperative complications also reduced in comparison with other clinic, where these recommendations haven’t been applied. CONCLUSIONS. The introduction of principles of prevention of complications in surgery according to WHO recommendations allowed significant decrease of the number of avoidable complications.

[Simultaneous abdominal and retroperitoneal surgery]

AIM

To study the results of simultaneous abdominal and retroperitoneal interventions.

MATERIAL AND METHODS

The article presents analysis of 856 simultaneous operations whose proportion was 3.49% of total number of operations. Most of them was performed via videolaparoscopic approach (697, 81.4%), open access and mini-laparotomy were used rarer (111, 12.9%) and 48 (6,7%) respectively). Severity of great number of interventions corresponded to degree I and II of D. Lochlein and R. Pichlmayer classification. Modern diagnostic methods including sonography, computed tomography, magnetic resonance imaging, angiography, endoscopy and laboratory data were used to define diagnosis.

RESULTS

Simultaneous approach increases duration of surgery 30.3% on the average that is significant risk factor in case of surgery of severity degree III and videolaparoscopic interventions. Simultaneous surgery does not significantly increase ICU-stay and incidence of postoperative complications.

[TRAUMATIC INTRAORGANIC HEPATIC AND SPLENIC HEMATOMAS]

An analysis of application results of complex research methods of diagnostics of intraorganic hepatic and splenic hematomas was made. At the same time, options of these methods were used for determination of prescription of injury. The ultrasound, CT, MR-imaging, videolaparoscopy, angiography, Doppler ultrasonics, impedometry, biochemical, laboratory and cytological study of punctate sample from hematomas were applied for this purpose in 33 patients. According to authors, an evolution of hematomas happened in 3 stages, each of this stage was characterized by specified data associated with investigation results. The staging procedure of hematomas or their evolution allowed setting the prescription of injury.

[Surgical management of traumatic retroperitoneal hemor-rhage]

AIM

To present the algorithm of management of victims using modern technologies including CT, laparoscopy, angiography, intraabdominal pressure monitoring, etc.

MATERIAL AND METHODS

Treatment of 395 victims with traumatic retroperitoneal hemorrhage was analyzed.

RESULTS

It was shown that the use of developed algorithm decreases mortality rate from 10.5 to 4.5% and postoperative complications incidence from 23 to 14.1% in reviewed patients.

[Discussion about therapeutic tactics in case of acute appendicitis]

The authors' opinion about conservative treatment of acute appendicitis is presented in the article. Conservative treatment of acute appendicitiswas proposed by K. Varadhan, etc. (2009). It was presented the examination results of 7216 patients who werehospitalized with suspected acute appendicitis. Also it was analyzed the results of appendectomy, which were performed in 5172 patients. Validity of diagnostic laparoscopy, informational content of ultrasonic scanning and Alvarado scale were discussed in the article. The authors propose that wide application of conservative treatment of acute appendicitis is premature in Russian Federation. Technique approbation is necessary on base of several medical organizations with discussion of its results within the Russian Society of Surgeons.

[Choice of surgical method of treatment of cholelithiasis]

This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.

[Emergency abdominal surgery in the region of Russian Federation (an analysis of 40 years)]

An analysis of the condition of emergency surgery for the patients with acute abdominal diseases was made in the period of 1972-2012. The dynamics of surgical beds provision and surgical personnel were taken into account. The authors investigated the rate of general and postoperative lethality, tendencies and regular occurrences and leading reasons of negative results in given diseases. Reserves of further decrease of the lethality were considered and it was associated with shortening of hospitalization part later than 24 hours. The future improvement of intensive therapy and resuscitation, more wide application of minimally traumatic techniques of surgical treatment could give better results in this group of patients.

[Diagnostics and treatment of the ischemic and reperfusion disorders by the intraabdominal ischemic syndrome]

Ethiology, pathogenesis, treatment and prevention of reperfusion disorders in emergency abdominal surgery are highlighted in the article. The thorough analysis of reperfusional disorders' pathogenesis by the abdominal compartment syndrome was carried out.

[Pathogenesis, treatment, and prevention of erosive-ulcerative lesions in the mucous membrane of the upper digestive tract]

The authors present results of examination and treatment of 698 patients with erosive-ulcerative lesions in the mucous membrane of the upper digestive tract that accounted for 39.49% of all subjects with gastrointestinal hemorrhage. These lesions were diagnosed in 73.8% of the patients in critical conditions. The leading role in their pathogenesis is played by ischemic-perfusion syndrome, gastric acid hypersecretion resulting in microcirculatory disorders, hypoxia, and activation of free radicals in gastric and duodenal mucosa. It is concluded that preventive and conservative therapy of the above lesions must be focused on the correction of ischemia and after-effects of reperfusion to achieve long-standing hypoacidic state (pH < 4) with the help of up-to-date antisecretory agents.

[Monitoring of intraabdominal pressure in colonic obstruction]

Results of surgical treatment of 197 patients with acute colonic obstruction complicated by intraabdominal hypertension were analyzed. Monitoring of intraabdominal pressure was made in 101 patients at the pre- and postoperative periods. Compensated, sub- and decompensated forms of obstruction depending on the data of intraabdominal pressure were determined. The level and dynamics of the intraabdominal pressure are taken as criteria of severity of acute colonic obstruction, decision on the time and volume of surgical procedures. The medico-diagnostic algorithm of management of such patients is proposed. Lethality turned out to be decreased to 15.8% as compared with a control group (24%) due to the monitoring of intraabdominal pressure and improved surgical strategy.

[Experience with hernioplasty after Lichtenstein in inguinal hernias]

The presented method of hernioplasty was used in 1242 patients with different types of inguinal hernias. In 428 patients plasty of the inguinal canal was performed by the classical method of Lichtenstein, in 814 patients the method was modified. The method modified by the authors is described in detail. Improved results of treatment are associated by the authors with reduced ischemization of the sutured tissues with reticulate endoprosthesis. Recurrent hernias were noted in 0.2% in the main group, and 1.8% in the control group.

[Hemostasis in acute gastrointestinal bleeding]

Retrospective analysis of treatment results was carried out in patients with acute bleedings from upper digestive tract according to efficacy evaluation of hemostatic methods. All methods of hemostasis were divided into 7 groups: resectional, local treatment of the bleeding source with or without vagotomy, angiosurgical, local surgical hemostasis, hemostasis along the length, endoscopic hemostasis and conservative modes. Indications for hemostatic methods were estimated depending on severity, intensity, character of the bleeding basing on the J. Forrest classification and severity of patient's condition (severity of blood loss). Prophylactic measures for prevention of recurrent bleedings after primary hemostasis are proposed. Differential approach to hemostasis in acute gastrointestinal bleedings allows achieving 96-97% efficacy.

[Syndrome of intracavitary hypertension in a surgical clinic]

The problem of intracavitary hypertension syndromes characterized by similar pathophysiological abnormalities and different etiological factors is investigated and discussed. Compartment syndrome is believed to be the extreme variant of the disease. Specific markers and methods of correction (including surgical intervention) of intracavitory hypertension in critical situations are considered.

[The treatment of patients with Mallory-Weiss syndrome]

Results of treatment of 345 patients with Mallory-Weiss syndrome were analyzed. Classification of the disease with a glance on stages and bleeding activity was given. Methods of hemostasis and indications for the surgical interference were discussed. The importance of consideration and respective treatment of the concomitant gastrointestinal diseases or alcohol intoxication was stressed.

[The Fournier's gangrene]

Data of 17 patients with the Fournier's gangrene are described and analyzed. The incidence of the disease is lesser then 0,09% of patients of urological and proctological departments. Patients with the Fournier's gangrene are to be treated and monitored at the intensive care units. Early and radical necrectomy, massive systemic antibiotic therapy and therapy of the systemic inflammatory response syndrome are the mainstay of the successful Fournier's gangrene treatment. Lethality of the disease amounted up to 17,6%.

[Comparative analysis of the scores of severity of acute pancreatitis]

Based on an analysis of case histories of 45 patients with destructive pancreatitis and coexisting peritonitis the authors have proposed a score assessment of the disease severity. It is based on accounting the morphological alterations in the pancreas and retroperitoneal fat, statistical data from case histories of the patients. This method of assessing the severity of acute pancreatitis is good for specification of the management of the patient in the hospital and for a retrospective analysis of the case history.

[Abdominal compartment syndrome in urgent surgery]

Results of measurement and monitoring of intraabdominal pressure at 288 patients treated for different abdominal diseases and trauma were analyzed. In early postoperative period the increase intraabdominal pressure to 10-15 mm Hg (I degree) was revealed at 161 (56.0%) patients, from 16 to 25 mm Hg (II degree)--at 95 (33.0%), from 25 to 35 mm Hg (III degree)--at 23 (8.0%), more 35 mm Hg (IV degree)--at 8 (2.7%) patients. When intraabdominal pressure decreased on 4-5 mm per day the prognosis was positive at 257 (89.2%) operated patients. Critical type regarded as compartment syndrome (III-IV degree) was diagnosed at 31 (10.8%) patients. Relaparotomy was performed at 23 (8.0%) patients with III degree hypertension, the lethal outcome was at 6 (26.1%) cases. Relaparotomy at 8 (2.7%) patients with IV degree hypertension was late, and all the outcomes at these patients were lethal. General lethality at compartment syndrome was 45.2%. It is concluded that monitoring of intraabdominal hypertension should be mandatory diagnostic method, and critical parameters of abdominal hypertension--absolute indication to repeated laparotomy and decompression of abdominal cavity.

[The ways of purulent spread in necrotizing pancreatitis]

Results of examination of 206 patients with destructive pancreatitis are presented. On the basis of complex research it has been allocated five most significant variants of distribution of purulent process to retroperitoneal space. Existence of correlation of morphological changes in pancreas and retroperitoneal cellular tissue has been shown. Contrast ductography allowed to identify more precisely a place of defect in a wall of a duct and to predict the ways of purulent spread in retroperitoneal space. In view of it surgical tactics allows to improve results of treatment.

[Prognostic value of the pattern of multiple organ dysfunctions in severe acute pancreatitis]

A relationship was studied between the outcomes of severe acute pancreatitis and the pattern and multiple organ dysfunctions in 72 patients. Organ dysfunction was observed in 39 (54.2%) patients: multiple organ dysfunction (MOD) in 20 (27.8%) patients and dysfunction of an organ or a system in 19 (26.4%). The deceased patients had a statistically significantly higher incidence of MOS than the survivors (88.2% versus 9.1%; p < 0.01). Logistic regression showed that only respiratory and neurological dysfunctions were the factors that predispose to death.

[Abdominoplasty during operations for ventral hernias]

Anatomic cadavers studies have shown the necessity of one-stage abdominoplasty during herniotomy for ventral hernias. An original method of hernioplasty was developed. It is demonstrated that abdominoplasty in all the cases reduces tension of tissues with maximal effect in defects of the anterior abdominal wall from 32 to 150 cm(2) and subcutaneous fat thickness more than 3 cm.

[Feasibility of correction of insulin insufficiency after autotransplantation of splenic tissue in duodenopancreatectomy]

Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.

[The effect of organ dysfunction on the outcomes of acute destructive pancreatitis]

The relationships between outcomes of severe acute pancreatitis (SAP) and organ dysfunction in 72 patients were studied. A total of 39 (54.2%) patients had organ dysfunction, 20 (27.8%) patients -- multiple organ dysfunction (MOD), 19 (26.4%) patients -- dysfunction of single organ or system. Died patients had higher incidence of MOD compared with those who alive (88.2 vs 9.1%, p<0.01). In multiple logistic regression analysis the main predicting factors of death were pulmonary failure and neurological dysfunction. Pulmonary failure was the most common organ dysfunction among both single organ dysfunction (57.9%) and MOD (95.0%), with a total morbidity of 41.7%. Mortality rate was lower at isolated pulmonary dysfunction, and was higher at MOD (18.2 vs 78.9%, p<0,01). Irregular specialized intensive treatment protocol led to groundless surgical interventions at 10 from 46 patients with sterile pancreonecrosis. Organ dysfunction makes worse the prognosis in patients with SAP. Choice of the optimal treatment strategy at SAP with MOD is determinative.

[Role of higher education institutions in doctors training and their health care]

Bashkirsky State Medical University served as an example for evaluating role of higher education institution in development of medical staffers in the region and their health care.

[Anatomic and clinical substantiation of laparoscopic and combined surgeries]

Criteria of laparoscopic approaches are substantiated. Advantage of combined procedures in difficult surgeries is proved. Microcirculation of the peritoneum and influence of different surgical approaches on it were studied. Minimal influence of minimally-invasive procedures on microcirculation is demonstrated.

[Combined mini-invasive operations in gastroduodenal ulcers]

The authors' experiences show that at the present-day stage of the development of mini-invasive surgery the combined method of operating consisting of laparoscopic and mini-laparotomic steps is a perspective alternative. In addition, the authors note high efficiency of combined operations having all advantages of mini-invasive surgical technologies which was confirmed by investigations of the effects of access on microcirculation of the peritoneum in different surgical accesses used in their clinic.

[Appliance of "LigaSure" generator in hemorrhoidectomy]

Results of hemorrhoidectomy in 185 patients were analyzed. In 82 patients of the study group surgery was performed with "LigaSure" generator. Control group consisted of 103 patients who underwent surgery by Milligan-Morgan method. Appliance of "LigaSure" generator to reduced time of surgery by 3.5 times (from 48+/-10.3 min to 13+/-3.7 min), pain syndrome -- 2.2 times, and dysuric disorders -- 2.4 times.

[Surgical treatment of patients with colostoma]

Results of treatment of postcolostomy patients are analyzed. In 74.7% cases colostoma was created due to tumor of the rectum or colon, in 6.5% -- due to diverticulosis, in 3.5% -- due to nonspecific ulcerative colitis, Krohn's and other diseases. Complications were diagnosed in 15.2% patients. Surgical treatment was carried out in 714 (43.6%) patients, 568 (79.5%) of them underwent reconstructive surgeries, 146 (20.4%) were operated for stoma complications. New methods of rectal stump preparation for surgery were used: method of differentiation of rectal stump and urether during surgeries, methods of delayed anastomosis. Laparoscopic mobilization of the colon during reconstructive surgeries led to a decrease of surgical trauma and number of complications.

[Minimally invasive and organ-saving operations in abdominal trauma]

Results of surgical treatment with modern minimally invasive methods of 968 patients with isolated and combined abdominal trauma were analyzed. These methods permitted to make topic diagnosis earlier and to perform adequate surgery on injured organs in 82.0% patients, including in 34.0% with endoscopic-assisted operations, in 36.0% patients diagnostic laparotomies were avoided. In spleen trauma organ-saving and replacement operations were performed for prophylaxis of postsplenectomy syndrome. Vagodestruction of the stomach and pancreas with electromagnetic waves was successfully used in 32 patients for prophylaxis of traumatic pancreatitis and gastrointestinal ulcers. Minimally invasive technologies and organ-saving operations permitted to reduce intra- and postoperative complications rate from 29.7 to 16.8%, lethality--from 12.3 to 7.4%.

[Diagnosis and surgical treatment of internal biliary fistula]

Results of examination and surgical treatment of 172 patients with internal biliary fistula (IBF) are analyzed. IBF was revealed in 0.22% of hospitalized patients with cholelithiasis. There were 4 variants of fistula formation. Combined spontaneous multiple fistula were described for the first time in 8 patients. Based on assessment of IBF's clinical symptoms formula for prediction of IBF development was proposed. Diagnostic potential of instrumental, X-ray, endoscopic and ultrasonic examinations was assessed. Differential surgical policy depending on IBF variant is described.

[Treatment strategy in diverticulosis of the colon]

The results of treatment of 645 patients with diverticular disease of the colon have been analysed. There were 65.4% of women and 34.6%--of men, 54.4% of patients were hospitalized urgently and 45.6% electively. 82.5% of patients underwent conservative treatment, 24.8% of them were operated. In hyperkinetic type of bowel motor activity preference was given to mini-invasive organ-saving operations. In 28 cases Laparoscopic serosa myotomy by Reilly and Hodson were carried out (in 17 cases through miniapproach). In hypokinetic type various types of resection of the colon (20 patients) were performed. In necessity for urgent operation various methods of operations may be made depending on general condition of the patient and extension of the pathologic process. In 29 cases initial resection with anastomosis has been performed. Postoperative complications developed in 20.5% patients. There were no lethal outcomes. In 66 cases 2-stage operations were carried out, lethality being 10.6%, and complications--23.7%.

[Vagotomy with high-frequency electromagnetic waves in surgical treatment in duodenal peptic ulcer]

Technical complexity and highly traumatic character of selective proximal vagotomy in all its modifications are considered to be the main causes of the postvagotomy complications. Experimental investigations in 38 mongrel dogs allowed the authors to develop and introduce into practice a new method of seromuscular proximal vagotomy with using radio waves. The selective destructive effect of the radio waves on the nerve tissues, evidenced by morphological investigations was taken into consideration and allowed the destruction of the vagus nerve branches in deep layers of the gastric wall to be performed. This method of vagotomy was used in 46 patients with ulcer disease of the duodenum and gave good results. When studying the functional state of the stomach and duodenum the authors widely used their modification of rheography of the gastric blood flow controlled by fibrogastroduodenoscopy in addition to routine methods of the functional diagnostics.

[Perspectives of using radiofrequency surgery in operations on the major duodenal papilla]

The article presents the results of an experimental study of the possibility of using radiofrequency surgery for performing papillosphincterotomy. A generator of radiowaves of a high frequency range was used for the generation of the electromagnetic field, which when acting upon the living tissues makes a cut and destruction of the tissue. The experiment was made in 20 dogs divided into two groups for acute and chronic experiments. In the group of chronic experiments the dogs were exterminated on the 7, 14, 21 and 35th days after operations. The area of the influence in all the periods of the experiment was investigated histologically. Significant advantages of the given method as compared with the traditional ones were revealed.

[The clinical picture and surgical treatment of adhesive intestinal obstruction]

Results of examination and treatment of 128 operated patients were analyzed. In addition to clinical and roentgenological data the ultrasonic investigation and laparoscopy were also made for diagnosis of commissural ileus. Prevailing was terminal ileus (109 patients). Dissection of the commissures was performed in 115 patients, dissection of the commissures with resection of the intestine was made in 29 patients. Combined operations were fulfilled in 17% of the patients. Sonic stimulation of the intestine was used parallel with medication at the postoperative period which led to earlier restoration of the intestine function. Serious complications were noted in 19 patients, 14 patients died. Main causes of the death were intoxication and peritonitis, hepato-renal and cardio-vascular insufficiency.

[Ultrasound examination in patients with peritonitis]

Ultrasonographic features of developed intraabdominal complications were in 73 patients, in 43 of them being local and in 30-diffuse peritonitis. The diagnosis was based on the complex manifestations of' sonographic changes of the small bowel and other organs of the abdominal cavity which the authors suggest to interpret as an ultrasound syndrome of "the bowel deficiency". The possibility of dynamic ultrasound control in postoperative period for registration of the features indicating elimination or progressing of peritonitis is shown.

[The minimally invasive surgery of gallstones and their complications]

The article analyzes results of treatment of 963 patients with cholelithiasis and with the complications of this disease. Operations on these patients were performed using the following methods: laparoscopy (422), minilaparotomy (373), wide (traditional) laparotomy (168). Recommendation for different ways of operations on biliary ducts are discussed as well as the necessity of taking into consideration the results of sonographical examinations, pathomorphological and rheographic changes when choosing a particular method of surgical treatment. A combination of two little-invasive methods of treatment of cholelithiasis complicated by peritonitis is suggested.

[Minimally invasive technologies in surgery of duodenal ulcer]

The results of surgical treatment of duodenal ulcer are presented. Combined miniinvasive method was used in 30 patients with perforated ulcers. The essence of the method consisted in laparoscopic sanation of abdominal cavity and operative manipulations in the area of perforated ulcer through mini-laparotomy approach. Taking into account destructive properties of radiowaves concerning nerve cells, the authors have proved in experiments feasibility of vagotomy by means of these waves, and used them for 10 patients in laparoscopic vagotomy combined with operative manipulations in the area of ulcer through mini-laparotomy approach. In 4 patients isolated laparoscopic radiofrequency vagotomy without gastric drainage in uncomplicated forms of duodenal ulcer was performed with good results.

[Spirometric evaluation of external respiration function in laparoscopic and mini-laparotomy cholecystectomy]

Spirometric parameters are studied in 54 patients subjected to laparoscopic cholecystectomy and cholecystectomy through a mini-laparotomy approach. The restrictive and obstructive disorders in the external respiratory function after minilaparotomy cholecystectomy are less expressed than after laparoscopic cholecystectomy. Thorough examination of the external respiratory function is recommended when defining the indications for laparoscopic cholecystectomy.