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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%.

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.

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%; p0.01). Logistic regression showed that only respiratory and neurological dysfunctions were the factors that predispose to death.

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%, p0.01). 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%, p0,01). 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.

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.

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.

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%.

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.

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 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.

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.

An analysis of 153 associated operations for diseases of the large bowel was made. Operations on the abdominal cavity were fulfilled in 25.5% of the patients, the other patients were subjected to perineal interventions. The authors consider that special attention should be given to the preoperative management, detection of concomitant diseases for more exact indications for associated surgical procedures, the latter being shown not to enlarge the amount of complications and the period of staying at the hospital.

Novokain retroperitoneal blockades were used in 150 patients with non-specific ulcerative colitis, diverticulosis and functional disturbances of the colon. The blockades allowed improving results of the treatment, normalizing the motor function, cupping off the inflammatory process, shortening the time of staying at the hospital.