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The clinical case presented in this article illustrates one of the rare manifestations of systemic sarcoidosis — an isolated sarcoidosis lesion of the spleen. In a 36-year-old patient, based on anamnestic information and preoperative instrumental examination, a nonspecific granulomatous lesion of the spleen was suspected. Surgical intervention was performed in the scope of laparoscopic splenectomy with subsequent morphological verification of the diagnosis. According to the pathohistological examination, the diagnosis of sarcoidosis of the spleen was established. The patient was discharged in a satisfactory condition on the 6th day.

The 3-year experience minimally invasive surgery for the treatment of the acute cholecystitis was summarized. Criteria of the access choice and terms of surgery were substantiated. Treatment tactics of the acute cholecystits with the use of minimally invasive surgery were outlined, which allowed to decrease the rate of unreasonable "open" operations.

The surgical treatment of postoperative ventral hernias (PVH) in patients with high operative-anesthesiologic risk (OAR) still remains a problem. The results of PVH treatment in 150 patients with different degrees of OAR are analyzed in the paper. Autoplastic operations and explantation of synthetic prostheses were performed. The second method demonstrated a range of advantages. The necessity of widening the indications for the planned surgery for PVH is proved, especially in patients with the increased OAR. This will permit avoiding complications of the hernia itself and decrease the frequency of urgent PVH surgery, very undesirable in such patients. The algorithm of the choice of reconstruction and anesthetic management is worked out.

The aim of the study is to work out the method of stimulation of postoperative wound healing after emergency abdominal surgery. Morphologic and morphometric studies showed that serotonin and/or NO-therapy use in the treatment of surgical laparotomic wounds furthers its healing by decreasing distrophic and inflammatory processes and favouring fibroblast proliferation, neoagiogenesis, collagen production etc. Results of 763 patients with laparotomic wounds treated with serotonin, mexidole and NO postoperatively demonstrate faster wound healing and absence of infectious suppurative complications.

Ureterolithotomy has an alternative which is much less invasive --retroperitoneoscopic ureterolithotomy (RU). Nineteen cases of RU are reported (15 males, 4 females). Thirteen patients have undergone RU as monotherapy, 5 patients--after ineffective sessions of extracorporeal shock wave lithotripsy, 1 patient--after contact ureterolithotripsy. Mean size of the stones was 12.8 (9.5-30) mm. All the stones were eliminated for one procedure. Duration of surgery in the first 5 operations was 1.5-2 hours, in subsequent ones--65-70 min. The number of bed-days varied from 2 to 10 days (4.2 days). One male had a postoperative attack of pyelonephritis which was treated with antibacterial drugs. RU is a safe and effective operation, it is justified when previous surgery was ineffective, in large, longstanding concrements of the upper and middle third of the ureter, monohydrate-oxalate concrements.

The aim of the study was analysis of retroparietoscopic operations made in patients with renal cysts, anomalies of the kidneys, uretero-pelvic strictures, concrements of the upper third of the ureter to optimize treatment policy. A total of 29 patients were treated in the urological department (17 males, 12 females, age 23-70 years, mean age--49.7 years). Of them, 18--for renal cysts, 4--for ureteropelvic stricture (postoperative structure--1, ureterovasal conflict--2, high position of the ureter--1), postoperative stricture of the lower third of the left ureter--1, urolithiasis--5 (located in the upper third of the ureter--4, located in the pelvis and lower calyces of the dystopic left kidney--1), hydroureteronephrosis of the upper half of the double right kidney--1. Ultrasound scanning was followed by multispiral computed tomography. Retroparietoscopic method is characterized by limited positions of the instrumental trochar, absence of definite anatomic marks and difficulties in maintenance of necessary pressure in the cavity. Valid position of the trochars in the retroperitoneoscopic operation is a necessary condition of successful operation. In retroparietoscopic interventions the operative approach includes creation of the primary cavity, placement of trochars and creation of working cavity. Duration of retroperitoneoscopic operations ranged from 1 hour to 4 hours 30 min. Only short-term fever was a complication. Postoperative hospital stay was 1 to 7 days. Thus, retroperitoneoscopic operations are a good alternative to conventional surgery.

Since 1994 till 2000 the authors have performed 1152 laparoscopic cholecystectomies. Coexistent diseases of the organs of the abdominal cavity were diagnosed in 13.02% of the patients operated on by using laparoscopic techniques. In parallel the simultaneous interventions were performed for hiatal hernias, ulcer of the duodenum, commissural disease of the peritoneum, chronic duodenal obstruction, ventral hernias, diseases of the genital organs, liver and chronic appendicitis. The greater volume of the operations when performing the associated operations by the laparoscopic method does not make the course of the postoperative period more severe and gives good results in 89.3% of the patients.

Minimally invasive technologies were used in treatment of 89 patients with cholelithiasis complicated by mechanical jaundice and purulent cholangitis. Advantages of the two-stage operative treatment of such patients were shown. The first stage is decompression of the bile duct, the second stage is a radical operation either by laparoscopic or minilaparotomic methods. It allows to avoid extensive and traumatic operations and secures better immediate and long-term results of treatment.

Results of treatment of 89 patients with cholelithiasis complicated by obstructive jaundice and purulent cholangitis using the minimally invasive technologies are analyzed. The advantages of two-stages surgical treatment of these patients are demonstrated. The decompression of biliary tract are performed as the first stage, radical operations by laparoscopy or minilaparotomy--as the second stage. This method permits to refuse the large and traumatic operations and to improve significantly the nearest and long-term results of treatment.