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Purpose. To study specific approaches for selecting patients with rhonchopathy and obstructive sleep apnea syndrome for surgical treatment and to study laser surgical techniques applied on the soft palate so as to identify basic reasons of postoperative complications, soft palate function disorders and relapses of the disease with an even more aggressive course than before the surgery.Material and methods. In 2011–2020, 523 patients with rhonchopathy and obstructive sleep apnea syndrome, aged 23–78, were selected for surgical treatment. The authors discuss the obtained data after analyzing the effectiveness of used criteria for selecting patients for laser-assisted surgery on the soft palate, as well as after analyzing outcomes after laser sculptural uvulopalatoplasty performed in 309 patients. Reasons for insufficient effectiveness of surgery in some patients have been analyzed too.Results. After analyzing selection criteria, it has been found out that only 309 patients out of 523 (59.1 %) had no contraindications to laser sculptural uvulopalatoplasty, while 214 patients (40.9 %) had them. The discussed surgery was effective in 304 out of 309 operated patients (98.4 %) which has been confirmed with a complete and stable relief from night snoring and its complications for five or more years after the surgery. No effect was registered in 5 (1.6 %) patients because they absolutely ignored strict following the prescribed regimen, diet and other recommendations aimed to promote physiological healing of surgical wounds.Conclusion. The effectiveness of laser sculptural uvulopalatoplasty depends on a careful and adequate selection of patients for this surgery as well as on rational choice of laser light parameters; failures are due to inadequate selection of patients and their unwillingness to strictly follow recommendations in the postoperative period.

The authors have reviewed researches on laser palate surgery and stages of its historical development for providing surgical care to patients with ronchopathy and the obstructive sleep apnea syndrome. They also assessed the effectiveness of traditional techniques for uvulopalatoplasty as well as the effectiveness of laser light application in uvulopalatoplasty and its modifications.

Despite of an obvious success in the management of cancer patients and in the quality of medical care for them, however there are still open questions on the effectiveness of prevention and treatment of complications after surgery, chemotherapy, and radiotherapy, as well as on the quality of comprehensive rehabilitation of such patients. One of the possible ways to solve these issues is low-level laser therapy.Laser therapy in Russia has been successfully used in many areas of modern clinical medicine for more than 50 years; it is still developing and improving. Main advantages of laser therapy are simplicity, comfort, and safety for patients, as well as low costs.The widespread use of low-level laser light has experimental and clinical justification. Awareness in principles of dosing, methodological features of laser procedures, justified prescription and strict compliance with indications and contraindications can ensure high effectiveness of the discussed therapy in oncologic patients.

Purpose: to evaluate the effectiveness of low-level laser radiation in the complex rehabilitation of patients with head and neck tumors after radical surgical treatment as well as to assess the influence of the discussed treatment on the quality of their life.Material and methods. 134 patients with head and neck cancer aged 23–78 years (mean age – 54.24 ± 12.7 years ) were taken into the study. There were 39 (29.1 %) men and 95 (70.9 %) women. All patients were divided into three groups. In Group 1 (n = 45), patients received traditional rehabilitation treatment (physical exercises, massage, medication); in Group 2 (n = 45), patients had a course of traditional rehabilitation plus low-level laser therapy (LLLT); in Group 3 (n = 44), patients had only several LLLT courses as rehabilitation therapy. For laser therapy, laser device “Azor 2K-02” (laser hazard of class II, GOST 12.1.040-83) was used.Results. During the treatment, most of the patients noted early disappearance or noticeable decrease in pain and numbness intensity at the site of the surgical; skin sensitivity and increase of the muscular tone in the shoulder girdle and upper limb at the site of the surgical were restored as well. The most pronounced regression of complaints after rehabilitation therapy was observed in patients who had LLLT in combination with other rehabilitative measures.Conclusion. Radical surgical or combined treatment of patients with malignant tumors of head and neck causes functional disorders of tissues and organs at the site of treatment. Rehabilitation therapy with LLLT in red and/or infrared spectrum range ensures adequate restoration of impaired functions what improves the quality of life of such patients.

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

To increase the effectiveness of treatment of colorectal cancer followed by metastatic liver lesion.This study included 319 patients with colorectal cancer and metastatic liver lesion Gennari grade I, II, and III for the period from 2002 to 2017. All patients received combined treatment. 107 patients underwent liver resections: right-sided hemihepatectomy - 10, advanced right-sided hemihepatectomy - 7, left-sided hemihepatectomy - 9, triple segmentectomy - 33, bisegmentectomy - 29, segmentectomy - 19 cases. Radiofrequency ablation of liver metastases was performed in 105 patients. Cool tip device with a power of 200 W was used for destruction. Fifty-seven patients underwent microwave destruction of liver tumor (AveCure MWG 881, 34 W). Transarterial chemoembolization by doxorubicin and HepaSpheres 150-250 ng was applied in 34 patients.Annual, 2-, 3- and 5-year survival was 83.1%, 73.5%, 60.2% and 24.6%, respectively after liver resection. RFA of liver metastases was followed by annual, 2- and 3-year survival near 73.5%, 53.3% and 32.1%, respectively. In case of MWA of liver metastases annual survival was 78.5%, 2-year - 63.3%, 3-year - 58.3%.Chemotherapy combined with targeted therapy, radiofrequency and microwave ablation is able to increase resectability up to 35-40% in patients with colorectal cancer followed by liver metastases. Minimally invasive procedures (RFA, MWA) reduce surgical risk in critically ill patients.Цель исследования ― повысить эффективность лечения больных колоректальным раком (КРР) с метастатическим поражением печени. Материал и методы. В данное исследование были включены 319 больных с КРР и метастатическим поражением печени I, II и III стадии (по Gennari), находящихся на лечении за период с 2002 по 2017 г. Все пациенты получали комбинированное лечение. При этом 107 больным выполнены резекции печени: правосторонняя гемигепатэктомия ― в 10, расширенная правосторонняя гемигепатэктомия ― в 7, левосторонняя гемигепатэктомия ― в 9, трисегментэктомия ― в 33, бисегментэктомия ― в 29, сегментэктомия ― в 19 случаях. Радиочастотная абляция (РЧА) метастазов в печени выполнена 105 пациентам. Для радиочастотной деструкции был использован аппарат Cool-tip мощностью 200 Вт. Микроволновая деструкция опухоли печени аппаратом АveCure MWG 881 мощностью 34 Вт была выполнена 57 больным. Трансартериальная химиоэмболизация опухолей печени препаратом доксирубицин, с гепосферами 150―250 нг проведена 34 пациентам. Результаты. При выполнении резекции печени продолжительность жизни составила: 1-летняя ― 83,1%, 2-летняя ― 73,5%, 3-летняя ― 60,2%, 5-летняя ― 24,6%. При выполнении РЧА метастазов печени продолжительность жизни однолетняя ― 73,5%, 2-летняя ― 53,3%, 3-летняя ― 32,1%. При выполнении микроволновой абляции (МВА) метастазов печени продолжительность жизни 1-летняя составила 78,5%, 2-летняя ― 63,3%, 3-летняя ― 58,3%. Заключение. Использование в комплексном лечении больных КРР и метастазами в печень полихимиотерапии в сочетании с таргетной терапией, РЧА и МВА позволяет увеличить резектабельность больных до 35―40%. Применение РЧА и МВА у соматически отягощенных больных уменьшает риск оперативного вмешательства за счет малоинвазивности и малотравматичности.

To improve an efficiency of surgical treatment of patients with cholelithiasis complicated by obstructive jaundice through antegrade interventional approach.166 patients aged from 23 to 92 years with cholangiolithiasis complicated by mechanical jaundice were enrolled. Patients were divided into 2 groups: group I (136) - retrograde endoscopic method, group II (30) - antegrade interventional approach.In the first group surgical efficacy was 79.4%. Morbidity and mortality were 13% and 2% respectively. In the second group these values were 96.7%, 10% and 3% respectively.Antegrade interventional approach for minimally invasive procedures is technically feasible, has the same effectiveness as the retrograde endoscopic method and also all advantages of minimally invasive techniques.Антеградный чрескожный чреспеченочный доступ - альтернатива эндоскопическому ретроградному методу лечения холангиолитиаза, позволяющая не только выполнить декомпрессию билиарного тракта, но и устранить холедохолитиаз, а также осуществить восстановительные манипуляции на терминальном отделе общего желчного протока и большого сосочка двенадцатиперстной кишки. Цель - повысить эффективность хирургического лечения больных желчнокаменной болезнью, осложненной холангиолитиазом, с синдромом механической желтухи посредством применения миниинвазивной антеградной рентгеноинтервенционной методики. Материал и методы. Выполнен сравнительный анализ результатов лечения 166 больных в возрасте от 23 до 92 лет с холангиолитиазом, осложненным механической желтухой. Больные разделены на две группы: в 1-й группе (n=136) применялся ретроградный эндоскопический метод, во 2-й (n=30) - антеградный рентгеноинтервенционный метод. Результаты. В 1-й клинической группе эффективность оперативного вмешательства составила 79,4%, частота осложнений - 13%, летальность - 2%, во 2-й группе - 96,7, 10 и 3% соответственно. Вывод. Метод антеградного рентгеноинтервенционного хирургического лечения холангиолитиаза является технически выполнимым, не уступающим по эффективности ретроградному эндоскопическому методу лечения, также обладающим всеми преимуществами миниинвазивных методик.

It is estalished that after surgical intervention the clinical manifestations of hiatal hernias are enhanced throughout the first year. The abdominal operation aggravates reflux-esophagitis. The limitations of indications to the operation based on the absence of visible in fibroesophagogastroscopy morphological changes are not always justified. Failure of supported antireflux mechanism even in uncomplicated forms of hiatal hernias in combination with abdominal cavity organs diseases involving surgical treatment is the indication to associative operative intervention, hernias elimination and correction of associative abdominal pathology.

A method of hiatal hernia surgery providing an opportunity to decrease postoperative complications has been proposed. The method eliminates the development of a pathologic hiatal narrowing during diaphragmocrurorraphy. The method has been used in 65 patients. The advantages of the method are demonstrated.

The problem of surgical management of gastric and duodenal ulcers associated with the hiatal esophageal hernias is reported. The authors have summed up the results of simultaneous surgical treatment of 97 patients. Good follow-up results were obtained in 69.2 percent of the patients, satisfactory in 26.9 percent and unsatisfactory in 3.9 percent of the patients. Of the 28 patients with reflux esophagitis who had previously undergone gastric resection, it was noted that nonresection of the associated hiatal hernia during the primary operation for ulcer disease decreased the effect of surgical treatment. A new method of surgical management of reflux esophagitis of the resected stomach is presented. The authors conclude that simultaneous operation for gastroduodenal ulcers associated with hiatal hernia is a promising area of surgical treatment and ensures high medical, social and economic efficiency.

The results of diagnosis and treatment of diseases of the stomach and intestine associated with diseases of the abdominal organs: hiatal hernia (97 cases), commissural disease of the peritoneum (31), calculous cholecystitis (28), abdominal wall hernia (22) are presented. In 34 patients, 3 and more diseases were revealed. Simultaneous operations were performed in 181 patients. At the long-term period, a good result was noted in 68.6%, a satisfactory one--in 25.5%, and unsatisfactory result--in 5.9%. The substantiated performance of simultaneous operations in patients of the given category is a perspective trend in surgery, it ensures the high medico-social and cost effectiveness of treatment.

The associated hiatal hernia, chronic cholecystitis and duodenal ulcer disease were diagnosed in 12 patients. Combined surgical operations were performed in 9 patients with a good long-term result.

The experience with surgical treatment of 112 patients with gastric and duodenal ulcer disease associated with pathology of the abdominal organs is summarized. Most frequently in ulcer disease, sliding hiatal hernia (34.1% of cases) and adhesive disease (25.7%) were revealed. In all the patients, the simultaneous operations were performed. The incidence of postoperative complications was 13% and didn't exceed that in the control group of patients, who underwent only the operations on the stomach and duodenum.

Currently, ultrasound (ultrasound) is given great attention in the recognition of acute surgical diseases of the abdominal cavity. This is due to its safety, non-invasiveness, short and easy for the patient period of study, and most importantly, high information content and the possibility of dynamic control with its help without significant adjustments to the patient's condition.

One of the common and difficult-to-treat complications after surgery for esophageal hernia is its narrowing, accompanied by dysphagia and severe pain syndrome. Surgical treatment of esophageal hernia includes fundoplication and suturing of the esophageal opening of the diaphragm on a probe under the control of the surgeon's fingers inserted into the esophageal opening. The data obtained in this case cannot be used for objective estimation of the degree of narrowing of the esophageal opening of the diaphragm necessary for hernia repair and sufficient for normal functioning of the esophageal-gastric transition, because individual anatomical features of the fingers and their orientation are highly variable for each particular surgeon.