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Objective: To compare laparoscopic and laparoscopy-assisted repair of perforated peptic ulcer using evidence-based methods., Material and Methods: A systematic review and meta-analysis were carried out in accordance with the recommendations of the Ministry of Health of Russian Federation and Cochrane Handbook for Systematic Reviews., Data searching was carried out in Russian and English languages using the E-library, Cochrane Library and PubMed databases. We analyzed titles and references in specialized journals and thematic reviews, respectively. Clarifying information was obtained via personal contacts with the heads of surgical hospitals. The RevMan 5.4 software was used for statistical analysis., Results: We found no randomized trials devoted to comparison of laparoscopic and laparoscopy-assisted surgeries in patients with perforated peptic ulcer. Meta-analysis was based on non-randomized trials with satisfactory methodological quality according to the I-ROBINS formalized assessment. Overall clinical material included 478 observations: 229 (47.9%) laparoscopic surgeries and 249 (52.1%) laparoscopy-assisted procedures via minimally invasive access. There were no conversions. Incidence of postoperative complications was 4.36 and 8.83% (OR=0.39, 95% CI 0.08, 1.87), postoperative mortality 0.87 and 0.81%, respectively (OR=1.26, 95% CI 0.08, 8.24). Laparoscopic surgeries were shorter (MD= -8 min, 95% CI -9.7, -6.4). Length of hospital-stay was also shorter after laparoscopic surgery (MD= -4.6, 95% CI -9.7, -6.4)., Conclusion: Laparoscopic operations are shorter and accompanied by lower incidence of postoperative complications and less hospital-stay. Large statistical power is required to confirm these differences.

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 Unpublished data were obtained via communication with chiefs of national surgical hospitals.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.

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.

Overall 3457 laparoscopic procedures after open and laparoscopic abdominal operations have been performed including 270 relaparoscopies due to intraabdominal postoperative complications. Basing on their own experience, the authors give methodological and technological recommendations allowing to increase diagnostic and surgical efficacy of relaparoscopy and to reduce the rate of complications.

Experience in 2277 laparoscopic surgeries performed in patients with history of conventional and minimally invasive surgeries is analyzed. Regularities of commissures formation after some surgeries are determined. Viscero-parietal commissures (VPC) which are the main cause of possible intraoperative complications were revealed in 1746 (76,7%) patients. Diagnostic value of special ultrasonic examination was 95,5%, on the average. Laparoscopic adhesiolysis in different types of adhesive disease was attempted in 195 patients, 170 (87,2%) procedures were finished successfully. Application of Interceed (TC-7) on parietal peritoneum was used in 14 patients to prevent repeated formation of commissures.

The indications to dissection of commissures in the algesic form of adhesive disease are determined. An experience with performing 36 laparoscopic operations is described. In 34 cases adhesiolysis was fulfilled under conditions of the I-III degree of the commissural process. Technical problems appeared while dissecting commissures in 2 patients with the IV degree of the commissural process due to pronounced dystopia of organs of the abdominal cavity. No complications were registered during operations. Control examination of 29 patients did not reveal recurrent diseases.