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Objective: To evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute abdominal surgical diseases., Material and Methods: A retrospective analysis of laparoscopic procedures in 4655 patients with confirmed or suspected acute abdominal surgical diseases for the period 2008-2017 was performed. Laparoscopy was applied to confirm or to determine unclear diagnosis., Results: Diagnosis was established and confirmed in 4526 (97.2%) patients. Advisability of laparoscopic surgery was confirmed in 3091 (68.3%) patients, laparotomy - in 491 (10.8%) patients. Surgical treatment was not required in 944 (20.9%) patients. Laparoscopic procedures were performed in 3050 (98.7%) patients, 41 (1.3%) patients required conversion to laparotomy. Laparoscopic approach failed to define diagnosis in 129 (2.8%) patients that required conversion to diagnostic laparotomy., Conclusion: Laparoscopic was valuable to establish the diagnosis and determine surgical strategy, diagnose concomitant diseases, perform operations including simultaneous ones.

The experience of treatment of 366 patients with haemophilia who were urgently hospitalized in hеmatological Scientific Center over the last 10 years is presented in the article. There were 114 (31.1%) patients with acute diseases of abdominal cavity organs, 150 (41%) patients with bleeding from upper gastrointestinal tract, 102 (27.9%) patients with acute hematomas of retroperitoneal space. Urgent operations were performed in 48 (22.2%) patients who were hospitalized with clinical symptoms of acute abdomen syndrome. It was developed the criteria of diagnosis and choice of treatment tactic on the basis of the received results. Application of presented algorithms led to improve the quality of urgent surgical care to patients with haemophilia.

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

Treatment results of 301 patients with intraabdominal hypertension were analyzed. Indications for abdominal decompression were substantiated and defined. Algorythm, the novel surgical technique and instrumentarium for different decompressive surgery by peritonitis, acute intestinal obstruction and pancreonecrosis. The use of the algorithm allowed to decrease the postoperative complication rate. Thus, the laparotomic wound inflammation and necrosis was 24% less, eventration frequency was 4 times less and the acute respiratory failure was 43% less. The lethality rate fall from 20.9% to 11.5%.

Owing the experience of 16 101 miniinvasive operations by acute diseases of the abdominal cavity, the authors pose that the introduction of polytechnological methods has certain perspectives. The combination of different methods with the use of modern technologies lead to better results.

Surgery on the reason of the "acute abdomen" in children often reveals the persisting vaginal peritoneal defects, which further lead to hernia formation. 23 children (aged 4-15 years) were operated on the acute uncomplicated appendicitis (n=10), acute mesadenitis (n=3), appendicular local and pelvioperitonitis (n=9) and ovary apoplexia (n=1). Inguinal hernia was revealed in all patients during laparoscopy. After videoendoscopic sanation of the abdomen and appendectomy (if it was necessary) the extraperitoneal ligation herniorraphy in author's modification was performed. The were no cases of abdominal complications as well as hernia recurrence among the treated patients.

The authors summarized the experience of the emergency surgical treatment of 965 patients with combined gynecological and general surgical diseases. Patients were aged 15-80 years. 410 (42.5%) of women were fertile. The laparotomic access was chosen individually, though the majority (965-97.2%) had the middle or oblique-transverse laparotomy. The volume and risk level of the operation were assessed using the score method. The most frequent diseases were: the acute appendicitis, the incarcerated ventral hernia, the intestinal tumor obstruction and the acute calculous cholecystitis. The high medical and economical efficacy of the simultaneous operations allow to recommend them , considering the proper high level of surgical help.

Clinical cases of various intra- and postoperative gastrointestinal complications in cardiac and aortic surgery are discussed. Surgical tactics by such complications, as well as possible preventive measures are adduced.

Results of emergency surgical aid by acute diseases of abdomen rendered in 39 Moscow hospitals were analyzed. Results of surgical service were analyzed generally during the period of 1993-2007, and in comparison according to 5-year intervals: 1993-1997; 1998-2002 and 2003-2007 years. Analysis demonstrated the progressive decrease in general lethality, as well as postoperative lethality. The observed improvement is associated with the development of material and technical support, introduction of new technologies, drug supply and resuscitation facilities.

Aim: Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas, accounting for 5 to 10% of all non-Hodgkin's lymphomas (NHL)., Patients and Methods: From January 1996 to November 2005, 10 patients with primary intestinal lymphomas were submitted with clinical signs of acute abdomen to the Pediatric surgical department in Sofia. The children presented with radiologically proven intussusception, ileal obstruction or peritonitis due to bowel perforation., Results: At exploration the tumor was located in the ileum in 4 cases, in the terminal ileum and coecum in 3 cases, appendix in one and multiple sites were found in 2 cases. Children with localized disease underwent radical resection of the tumor mass with ileo - transverso anastomosis (3), partial bowel resection (4), and appendectomy (1) whereas in 2 children with advanced disease diagnostic biopsy alone with temporary ileostomy in one were accomplished. According to histology, 5 patients had Burkitt lymphoma and 5 lymphoblast NHL. The children were treated according CHOP. Over five - years relapse - free survival for localized disease accounts 6 children., Conclusion: Primary NHL in children often presents with acute abdominal condition requiring surgical exploration. Prognosis depends of adequacy of surgical resection and the adjuvant chemotherapy.

One hundred and ninety-two urgent laparoscopic operations in 179 infants (including 31 newborn infants) were performed. Indications for surgery were intestinal obstruction (108 children), acute diseases of abdominal organs (61), and gynecological diseases (10). The rate of conversion in 3 groups was 10.9, 4.6% and 0, respectively. In all the cases conversion was performed due to technical difficulties, there were no intrasurgical complications, diagnostic value of the method reached 100%. Combined laparoscopic surgeries were performed in 25.1% cases. Intestinal invagination was the most frequent cause of laparoscopy. Comparative analysis of open (28) and laparoscopic (85) desinvagination demonstrated the advantages of the latter one both during and after surgery. Laparoscopy is the useful method for diagnosis and treatment of acute abdominal disease requiring urgent surgery in infants.

The role of endotoxin aggression in the development of hemostatic disorders was analyzed in 62 children who had undergone urgent and elective surgeries. It is demonstrated that indices of endotoxin-antiendotoxin system and hemostasis before surgery may be regarded as prognostic criteria for development of complications during and after surgery.

2765 children with abdominal pains were observed in the clinic of pediatric surgery from 1995 to 1999. During the observation period the abdominal pains persisted in 85 children. As it was not possible to resect the acute abdominal diseases, these children underwent diagnostic laparoscopy. Destructive changes in the appendix were revealed in 12 patients, 73 patients have avoided unnecessary laparotomy and appendectomy. It is concluded that diagnostic potential of laparoscopy is not inferior to diagnostic laparotomy. Moreover laparoscopy has advantage as a method of final diagnosis.

Bacterial contamination of the abdominal cavity was studied in 30 children aged from 2.5 to 14 years with acute abdominal conditions. Anaerobes were detected in 63.9% of the children. It was established that on the initial stages of development of acute diseases in the abdomen the antagonism between aerobes and anaerobes was not present. 3 days and later after surgery the antagonism between aerobes and anaerobes arises which results in potentiation of the inflammatory process by either aerobes (25% of cases) or anaerobes (75% of cases). The complicated course of postoperative period in patients with acute abdomen more than in 83% of cases is due to anaerobes and in 50%--to aerobes.

582 laparoscopic operations for various urgent diseases of the organs of abdominal cavity were made. 190 of them were performed for acute appendicitis, 266--for acute cholecystitis and its complications, 33--for pancreonecrosis, 39--for perforated gastro-duodenal ulcers, 32--for acute bowel obstruction and 22--for other pathological conditions. The necessity of conversion to conventional open surgery has arose in 41 (7.0%) patients. Intraoperative complications were detected in 7 (1.3%) patients. Postoperative complications developed in 18 (3.3%) patients. 2 patients (0.4%) died. The obtained results of treatment made it possible to recommend laparoscopic operations in acute abdominal diseases.

The aim of the study is the development of integral methods for early diagnosis and treatment of systemic pathobiochemical disturbances in patients with diabetes mellitus under conditions of acute surgical endotoxicosis as well as optimisation of surgical policy and drug pathogenetic correction. Blood lipids peroxidation (malonic dyaldehyde content in NADF and ascorbate-dependent systems, intermolecular sewings in erythrocytes membranes) and central hemodynamic parameters. The study was carried out in 199 patients with acute surgical diseases accompanied with diabetes mellitus. Peculiarities of the course of the disease were revealed in dependence of the form of blood lipoperoxidation. The scheme of intensive care in conditions of decompensation of diabetes mellitus aimed at correction of pathobiochemical disturbances in patients with acute surgical endotoxicosis has been developed.

Proceeding from a comprehensive literature survey the urgency of acute abdomen conditions in elderly and senile patients is thoroughly discussed. Not infrequently, geriatric surgeons face serious difficulties of diagnostic and therapeutic character relating to the severity of clinical picture and elevated postoperative lethality, explaining in turn the great surge of interest in the problem. Recent achievements along this line, surgery in particular, provide for adequate conditions for performing early surgical interventions with reduced intraoperative risk in elderly and old age patients presenting acute abdomen.

In the period 1990 through 1995, one-hundred patients operated for acute abdomen or admitted on a routine basis, presenting evidence of anaerobic infection, undergo treatment in the clinic of emergency surgery. Septic shock develops in 10/100 patients (10 per cent). In six of the latter the outcome is fatal--three with infection caused by spore-forming anaerobes (gas gangrene of the inguinal region--of Fournier, and anterior abdominal wall--anus praeternaturalis--two), and three with infection caused by non-spore-forming anaerobes (mixed anaerobic-aerobic infection). Anaerobic surgical infection and septic shock specificity is discussed, with an algorithm of therapeutic approach, based on clinical experience had with 100 patients, being proposed in either of them. Special emphasis is laid on antibiotic prophylaxis against anaerobic surgical infection. Its implementation in the concrete clinical conditions in this country demands a clearcut hospital drug policy (adoption of the "Drug Formularies" system), and elaboration of a new economical approach to the choice of antibacterial agents (using some of the forms of pharmaco-economical analysis, practicable with a view to the Bulgarian health-care model).

Serious abdominal complications occurring after chest and lung operations are discussed. The most common abdominal complications include acute dilatation of the stomach, paralytic ileus, gastrointestinal tract hemorrhage, as well as perforations of hollow abdominal organs. An interesting case presenting perforation of the small intestine after lung resection for pulmonary carcinoma is reported. The attention of surgeons is called to severe surgical complications, such as profuse hemorrhages from the gastrointestinal tract, and perforations of hollow abdominal organs, first and foremost.

The work analyses the results of emergency laparoscopy in 4,730 patients with acute surgical pathology of the abdominal organs. There were 26.3% of males and 73.7% of females; 26.5% of patients were of an elderly age. Laparoscopy was undertaken in all cases in which the diagnosis was questionable but the clinical picture was that of "acute abdomen" and in patients with an established diagnosis for conducting therapeutic manipulations: microcholecystostomy, drainage of the abdominal cavity. The authors show differential endoscopic signs of some acute surgical diseases of the abdominal organs. Laparoscopy confirmed the clinical diagnosis in 45.5% of cases and revealed indications for an emergency operation in 896 patients (33.8%). Laparoscopic microcholecystostomy was performed 137 times and drainage of the abdominal cavity 398 times. The diagnostic value of laparoscopy came to 97.1% on the average.

The life of the patients having aneurysms of aorta abdominal is in danger seriously because of the strong tendency of the aneurysms to make ruptures with the expansion of the diameter. The inhibition, even the retardation of the expansion of the aneurysms is impossible and the treatment can be only a surgical one. Stating the diagnosis aneurysm of aorta abdominal in the not specialized hospitals appears possible only in 30-50% from the cases. The frequency of the faults with the symptomatic aneurysms is comparatively high and 50% of the patients are being set for operations with a diagnosis "acuta abdomen". In the cases of ruptures the number of the faults reaches up to 72%. The lethality of the planned operative treatment is 3-5%. The lethality in the cases of urgent operation with ruptures is 50-75%. In order to avoid the faults and the complications in diagnosis of the illness we have made practical recommendations for consideration and discussion of the diagnosis and the tactics with patients having abdominal aneurysms. They are recommended for use in dispensary, surgical, urological and cardiological consulting rooms and the respective departments of the hospitals without special profile.

Vacuum therapy was applied in the management of 63 patients with postoperative ventral hernias, 101 patients with a similar pathological conditions were treated by the traditional method for wound healing. From analysis of the results of treatment and with due consideration for the results of additional methods of examination it was established that vacuum prevents accumulation of exudate and blood clots in the wound cavity and removes the risk medium for the development of pyo-inflammatory complications. Moreover, by promoting the coming together of the wound edges and liquidation of the wound cavity, vacuum therapy affects the metabolic reorganizations in the tissues and leads to stabilization of the regeneration mechanisms. The use of vacuum therapy in the postoperative period creates the possibility of regulating the reparative reactions through an active effect on the healing of the wound in the phase of inflammation, protecting in this manner the biology of the wound process and preventing infectious complications.

Complex research made it possible to reveal factors influencing timely hospitalization of patients by studying the causes of timely and late hospitalization, medical erudition of the urban and rural population, as well as the organization of emergency medical service in the prehospital stage. New methodical approaches to health education among the population as well as measures for raising the confidence of the sick in doctors of emergency aid service and surgeons are suggested. From the example of urban health service the authors emphasize the importance of the principle of necessary hospitalization of patients for profound examination in all cases of a doubtful diagnosis of an acute surgical disease.

Reviewing the literature, the authors discuss the diagnostic and surgical problems of abdominal adhesion disease in emergency surgery. The etiology and pathogenesis of adhesion disease is complex and still poorly understood. A number of etiologic factors are considered responsible. The authors formulate the current concepts on the pathogenesis of this disease and some classifications in the world literature. Adhesion disease is a major problem in emergency surgery, especially the form known as acute breed ileus. The prophylaxis, conservative and adequate operative treatment are of great importance.

The authors analyse the importance of the psychological barrier in the choice of the method of treatment in performing relaparotomy. Proceeding from the fact that the surgeon's psychological barrier is an objective factor aggravating the results of management of postoperative complications, the authors suggest that the indications for relaparotomy should be considered collectively. They believe that the second operation should be carried out by another, more experienced surgeon of the department. The surgeon who performed the first operation acts as an assistant during the relaparotomy.

The results of laparoscopy in 1,000 patients with various diseases are analysed. The indications for laparoscopy in different groups of patients are shown. Various laparoscopic operations were carried out on 789 patients. The most frequently performed interventions were cholecystostomy (n = 229), liver biopsy (n = 195), cholecystostocholangiography (n = 75), and diathermocoagulation of the hepatic surface (n = 36). Curative measures used in patients with obstructive and parenchymatous jaundice are discussed. The significance of diagnostic laparoscopy in emergency surgery is shown.

Insufficiently studied problems of late hospitalization of patients with acute surgical diseases of the abdominal organs are discussed from the standpoint of a systemic approach. The mean annual (1982-1986) index of late hospitalization was 1.8 times lower in rural districts of the Rostov region than in urban ones. The level of late hospitalization decreased significantly in towns with a 100,000-150,000 population. The index of late hospitalization was found to increase with the age of the patients. A seasonal pattern of the indices of late hospitalization and a high level of late hospitalization among medical workers were revealed. Study of the patient's medical histories showed factors causing delayed hospitalization. Information collected among the population by means of a questionnaire confirmed insufficient qualification and accessibility of the medical service, which influences essentially the tendency of most of the interrogated persons to temporize or resort to self-treatment when acute, growing pain appears in the abdomen.

Experience in the treatment of 156 patients with postoperative fistulas of the colon is discussed. The etiopathogenesis of the fistulas was revealed. The authors characterize pyoseptic complications and show the practical significance of their differentiation into formed and unformed types, which determined the therapeutic strategy and the outcomes. Preference was given to nonoperative treatment of the fistulas before their formation and subsequent single-stage closure by surgery. When nonoperative treatment was ineffective, various types of operative methods for exclusion of the fistula were applied (as the first stage).

A review of the literature is made on the complicated course of infectious and parasitic diseases, in which acute surgical abdomen syndrome develops. Surgical treatment of complicated infectious and parasitic diseases is a complex endeavour both from surgical and epidemiologic aspect. The high mortality rate after operations in complicated forms is associated with tactical errors in the surgical treatment and erroneously estimated extent of the surgical intervention.

In a series of 4350 children with abdominal surgical diseases operated at the Department of Pediatric Surgery in Sofia for a period of 3 years (1987-1989) the authors have observed 4 cases of pleuropulmonary complications (0.09 per cent). In two of these children the primary abdominal operation was for liver echinococcus, in 1--rupture of the liver and subphrenic abscess and in 1--perforative appendicitis and purulent peritonitis. Symptoms of respiratory failure developed in addition to the abdominal symptoms. Leading in the complex treatment was sanation of the abdominal cavity from the purulent process and double pleural drainage. The severe pathologic changes in the organs of the two adjacent cavities were responsible for the high case fatality rate (25 per cent).

Eighty-three patients with surgical abdominal pathology were included in the study. On the isotopic nephrogram they all had bilateral symmetric and analogous pathologic changes with varying degree of severity. The most common cause of renal function changes in patients with abdominal pathology was the reduced intravascular volume or vascular capacity changes, registered on the isotopic nephrogram with characteristic symmetrical pathologic curves. The sharp renal perfusion decrease, leading to decrease of glomerular filtration and diminution of diuresis explains the bilateral changes in the isotopic nephrogram which most frequently resemble obturation. The curves returned to normal 1 to 2 weeks after the physiologic state of the patients was stabilized, indicating extrarenal origin of the registered changes in the isotopic nephrogram. The latter should carefully be interpreted, in view of the possible influence of it of extrarenal factors.