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Thirty patients with colon disease in need of urgent surgery have undergone resection of the colon with formation of terminal afferent colostomy and compressive colon-colon anastomosis using oval and linear nikelid-titanium implants. Complications were seen in 6 (20%) patients, lethality was 6,7% due to multiorgan failure in the presence of generalized peritonitis. There were no complications due to colon-colon anastomosis. The above method permits one to reduce surgical trauma of future reconstructive surgeries.

The authors discuss the term "relaparotomy" and such its definitions as "early", "delayed", "late", "elective", "targeted", analyze different classifications of relaparotomies, propose their own definition of this term based on objective criteria of general reaction to surgical stress in the form of Seli[symbol: see text] adaptation syndrome which has definite duration (60 days). This fact may be regarded as a clinical criterion of determination of relaparotomy's terms. Surgery may be named as relaparotomy when it is performed in terms of adaptation syndrome (60 days). If surgery is performed after the end of adaptation syndrome it must be regarded as repeated operation.

Extirpation of the stomach accounts for 55.5% of all radical surgery for gastric cancer. Five hundred and sixty-two operations with creation of invaginated esophageal-intestinal (gastric) anastomosis were performed. The surgical technique is presented, its positive points are demonstrated. Main advantages of the invaginated anastomosis are physiologic function in postoperative period and a decreased rate of sutures insufficiency. Complications after extirpation and proximal resection of the stomach were seen in 17.6% cases, 5.9% patients died. Insufficiency of anastomosis sutures was in 8 (14%) patients, 4 (0.7%) of them died.

Three features of ulcer prevalence in Russia and therapeutic policy in ulcer consist of an increase of ulcerous patients number, a decrease of elective operations number for uncomplicated ulcers and an increase of emergency operations rate in complicate ulcer. Decrease of elective operations number leads to increase of emergency operations rate in complicated ulcer. The majority of complicated ulcers has long-term anamnesis, complications develop in chronic ulcers. Expansion of indications to elective operations in uncomplicated gastric and duodenal ulcer is advocated.

The article is devoted to classification of sepsis. Two classifications are compared: the Russian one, developed in A.V. Vishnevsky Institute of Surgery (phase I--the initial one or toxemia, phase 2--septicemia; 3--septicopyemia), and the American one, accepted in 1991 in Chicago which singles out three forms of sepsis (sepsis, severe sepsis or sepsis-syndrome, and septic shock). Both classifications are thoroughly analysed and it is stated that there is no principal disagreement in the definition of phases of the course and description of clinical stages of sepsis. The necessity for universal classification of sepsis is emphasized.

The analysis of 36 case records of patients with peritonitis (n = 12) and intestinal obstruction (n = 24) is presented. Nasogastrointestinal intubation of the small bowel was used in combined treatment. The aims, indications and contraindications for the intubation are formulated. Bacteriologic and biochemical parameters of bowel content were studied. It was established that the quantity of enterobacteria and unfermenting gram-negative bacteria was increased in intestinal paresis, the alkaline phosphatase, amylase, bilirubin, transaminase, a potassium content were increased as well. For the tube to function from the first hours after its introduction it should be periodically properly washed with sodium hypochlorite in concentration 300 mg/l.

816 patients were operated on because of gastric tumors; in 55 cases they were nonepithelial. Lymphomas have been found in 18 cases, glomus tumors--in 13 cases, leiomyomas, neurinomas and lipomas--in 11 cases, carcinoid--in 7 cases, aberrant pancreas--in 5 cases, gastric wall cyst--in 1 case. In half of the cases tumors were malignant. The preoperative diagnosis was absolutely correct in 30.9% patients and in 61% of cases with gastric lymphomas. All patients with nonepithelial gastric tumors should be operated on. In gastric lymphoma extirpation of the stomach is the operation of choice. In nonmalignant tumors with infiltrative growth and a size not more than 3 cm a stomach resection should be done, in a smaller size--a wedge resection and in subserous small tumors its enucleation, in submucous variant--endoscopic removal is possible.

Gastric juice acidity was examined in 131 patients with gastric ulcer. In 31 (23.7%) patients it appeared to be high, in 57 (43.5%)-normal, in 42 (32.8%)-low. In 28.6% cases the pepsin concentration was high, in 26.5%-normal, in 44.9% - low. In elder patients, patients with cardial ulcer, plural and combined ulcers, big size ulcers, long-term ulcer anamnesis the rate of low acidity increases. Among patients with unsatisfactory results of conservative treatment 15.8% had high acidity and 38.7% low acidity. Low acidity is an unfavorable prognostic factor.

During a period of 10 years 487 patients were under observation, in whom 528 glandular-villous and villous tumors of the rectum and colon were recognized. Malignancy was 11-12% in the colon and 26.3% in the rectum. Endoscopic removal of villous tumors was conducted in 78.9%, transanal excision in 6.5%, and resection of segments of the large intestine in 13.7% of patients. Large villous tumors of the large intestine must be managed by operations of a more radical character.

Various surgical interventions were conducted in the clinic on 63 patients for perforation of pyloric and prepyloric ulcers. Closure of the perforated ulcer was performed in 8 patients, excision of the ulcer and transverse pyloroplasty in 14, truncal and selective vagotomy in combination with antrumectomy in 6, and truncal vagotomy and pyloroplasty in 3 patients. According to the authors, the operation of choice is anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy and obligatory excision of the ulcer for histological study, and transverse pyloroplasty of the Aust-Holle type which was performed in 22 patients. The indications for radical operations were expanded bearing in mind the peculiarities of the course of peritonitis in patients with perforated gastric ulcers. In addition to the traditional prophylactic treatment of the abdominal cavity, the complex treatment of peritonitis included the use of low-frequency ultrasound during the operation and prolonged laparoscopic prophylactic treatment with low-intensity laser beam in the postoperative period.

The choice of the operative method in gastric ulcer is determined by the peculiarities of ulcer development mechanism and the role of acid production in the process and by oncological reasons. Bearing in mind that acid production is of little significance in the pathogenesis of gastric ulcer, while malignant degeneration of gastric ulcers is quite a reality, the authors consider resection of the stomach to be the most expedient operative method in its ulcer. Among 73 patients with gastric ulcer 70 (95.94%) were treated by resection of the stomach. Depending on the localization of the ulcer, the volume of the resection ranged from antrumectomy to gastrectomy. Five (7.14%) patients died after the operation, 3 from thromboembolic complications and 2 from peritonitis. The late-term, results were studied in 53 (81.54%) patients and were found to be good in 44 (83.02%), satisfactory in 5 (9.43%), and poor in 4 (7.55%) patients. Malignant degeneration of the ulcer was encountered in 7 (10%) of the 70 patients who were operated on. The authors prefer resection of the stomach with the formation of Roux-en-Y anastomosis which prevents reflux gastritis, recurrent ulcer, and the development of tumors. This is confirmed by the late-term results.

Operations were conducted on 253 patients with acute cholecystitis, which was gangrenous in 84 (33.2%) and perforative in 7 patients. No relation was found between the frequency of these forms and the patients' age and duration of the disease. Quite frequently the clinical picture did not correspond to the morphological changes in the gallbladder wall. On 17 (20.23%) patients the operation was performed in the first 24 hours after hospitalization and circumscribed or generalized peritonitis was often found; 57 patients (67.85%) underwent operation on day 2-3 and infiltration was found in 24 and circumscribed peritonitis in 8 patients; in 10 cases the operation was conducted after day 3, the clinical manifestations of the disease were scarce. All were treated by cholecystectomy, postoperative complications developed in 5 (5.95%), 2 (2.38%) patients died. The authors recommend more active surgical tactics and claim that cholecystectomy in the most substantiated operation which can be practically carried out in all cases.

The morphological and functional features of invagination ++esophago-enteric and esophagogastric anastomoses were studied in 234 of 266 patients who underwent gastrectomy or proximal resection of the stomach for cancer in 1972-1989. Two valuable stable properties were found to be characteristic in normally functioning invagination anastomosis: reliable anti-reflux properties and evacuation in portions. They are ensured by the obturating apparatus of the anastomosis, which consists of a valve and a muscular sphincter. No functional disorders on the part of the anastomosis were encountered in all periods after the operation in 174 (74.4%) patients. Complications developed in 60 (25.6%) patients (acute anastomositis, spasm of the anastomosis, reflux esophagitis, cicatricial stricture, and the dumping syndrome); they were attended by disorders of the function of the anastomosis due to temporary or constant disorders of the function of the obturating apparatus.

With the introduction of ultrasonic examination (USE) and computed tomography into practice, nonparasitic cysts of the liver are recognised much more frequently. They were revealed by USE in 0.99% and by computed tomography in 2.3% of cases. The author analyses 90 patients with hepatic cysts, 13 of them had oncological diseases, 15 had cholecystitis and pancreatitis, and 26 had ischemic heart disease and hypertension. A complicated course and rapid growth of the structures were the indications for operation. Percutaneous puncture was conducted in 5 cases, 3 patients were operated on for cysts of the liver, in 5 patients the operation on the cysts was performed during cholecystectomy. The most expedient palliative intervention is excision of the external wall of the cyst and tamponade of the remaining cavity by a part of the greater omentum on a pedicle.

Anatomical examinations (33 cadavers) for studying parasympathetic innervation of the upper abdominal organs formed the basis for developing a new variant of proximal gastric vagotomy--anterior seromyotomy of the body and fundus of the stomach in combination with posterior truncal or posterior selective vagotomy. This variant excludes mobilization of the esophagus and makes it possible to preserve the ligament apparatus of the esophago-gastric junction as well as the parasympathetic innervation of the pancreas, small and large intestine, kidneys, and adrenals, which may be a measure for the prevention of some ++post-vagotomy complications.

Anterior seromyotomy of the body and fundus of the stomach was combined with posterior truncal vagotomy and excision of the ulcer in 23 patients with gastric ulcer complicated by bleeding or perforation. Seventeen patients had chronic ulcers of the body of the stomach (type I), 3 patients had concurrent ulcers (type II), and 3 more patients had acute ulcers of the body of the stomach. Operation was undertaken for active bleeding from the ulcer in 20 patients and for perforating ulcer in 3 patients. One patient died. Mild disorders of evacuation of an aqueous barium sulfate suspension from the stomach were noted in 4 patients.

Experience with the treatment of 130 patients with generalized purulent peritonitis is analysed. The complex of therapeutic measures included intraoperative cleansing of abdominal cavity with ultrasound; postoperative prolonged laparoscopic cleansing with the use of rational antibacterial therapy and laser irradiation of the abdominal cavity. The cell immunity values in patients with peritonitis were studied and the principles of immunocorrective therapy substantiated. It is shown that detoxification measures are necessary in the treatment of this category of patients. A complex approach to the treatment of purulent peritonitis led to a decrease in mortality to 13.8%.