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AIM: to estimate the features of pseudomembranous colitis in patients with COVID-19, diagnostics, conservative treatment and surgery for complications.PATIENTS AND METHODS: a retrospective analysis of 396 patients with pseudomembranous colitis (PMC) in patients with new coronavirus infection was carried out for the period from March 2020 to November 2021. Among them there were 156 (39.3%) males, females — 240 (60.6%), moderate and severe forms of COVID-19 occurred in 97.48%.The diagnosis of PMC was established due to clinical picture, laboratory, instrumental methods (feces on Cl. difficile, colonoscopy, CT, US, laparoscopy).RESULTS: the PMC rate in COVID-19 was 1.17%. All patients received antibiotics, 2 or 3 antibiotics — 44.6%, glucocorticoids were received by all patients. At 82.8%, PMC developed during the peak of COVID-19. To clarify the PMC, CT was performed in 33.8% of patients, colonoscopy — 33.08%, laparoscopy — in 37.1% (to exclude bowel perforation, peritonitis). Conservative treatment was effective in 88.8%, 76 (19.1%) patients had indications for surgery (perforation, peritonitis, toxic megacolon). Most often, with peritonitis without clear intraoperative confirmation of perforation, laparoscopic lavage of the abdominal cavity was performed (60 patients — 78.9%, mortality — 15.0%), colon resection (n = 6 (7.9%), mortality — 66.6%), ileo- or colostomy (n = 8 (10.5%), mortality — 37.5%), colectomy (n = 2 (2.6%), mortality — 50.0%). The overall postoperative mortality rate was 22.4%, the incidence of surgical complications was 43.4%. In addition, in the postoperative period, pneumonia was in 76.3%, thrombosis and pulmonary embolism in 22.3% of patients. In general, the overall mortality in our patients with PMC was 11.4%, with conservative treatment — 8.8%.CONCLUSION: pseudomembranous colitis is a severe, life-threatening complication of COVID-19. In the overwhelming majority of patients, conservative therapy was effective, but almost 1/5 of patients developed indications for surgery, the latter being accompanied by high mortality and a high morbidity rate. Progress in the treatment of PMC, apparently, is associated with early diagnosis, intensive conservative therapy, and in the case of indications for surgery, their implementation before decompensation of the patient’s condition and the development of severe intra-abdominal complications and sepsis.

EDITORIAL COMMENT. Gripped aggressive foreign bodies (magnetic balls) in the gastrointestinal tract require emergency actions to clarify their localization and to remove them. The conservative approach with four-day observation described in the article should not be used.Introduction. Internal fistulas in foreign bodies of the digestive tract is a very rare complication.This publication is aimed to describe a rare case of fistula formation between the vermiform process and the ileum caused by magnetic foreign bodies.Clinical observation. As his parents said, a 2-year-old child swallowed magnetic balls; no clinical manifestations were noted. Plain radiography 3 days after the ingestion revealed foreign bodies (3) in the right lower quadrant of the abdomen. No foreign bodies were found on colonoscopy. Laparoscopy revealed a fistula between the appendix and the terminal ileum. The following steps were made: disconnection of fistula, appendectomy, suturing of fistula opening in the ileum.Conclusion. One of the complications after swallowing magnetic foreign bodies may be formation of internal intestinal fistulas. In our observation, the fistula was between the appendix and the ileum. No similar observations were found in literature.

The results of the treatment of 645 patients with the large intestine diverticulum (women 65,4%, men 34,6%) are analyzed. As many as 54,4% of the patients were hospitalized in case of emergency, 45,6% of the patients in planned cases. The conservative treatment was given to 82,5% of the patients, the operative theatment to 24,8% of the patients. In the hyperkinetic type of intestine motility, preference was given to low invasive operations conserving organs (in 28 cases the Reilly and Hodgson laparoscopic seromyotomt were carried out, in 17 cases through miniaccess), in the hypokinetic type the various kinds of large intestine resections were carried out (in 20 cases). In cases of emergency depending on the general state of a patient, nature and incidence of the pathologic process, the possibility of choosing various intervention methods is presented (in 29 cases the primary resection with anastomosis was carried out).

The results of examination of 130 patients with the irritable colon syndrome are analyzed. The patients were divided into 4 groups depending on the disease duration (up to 3 years 40 patienrs, from 3 to 6 years 40 patients, from 6 to 10 years 30 patients, more than 10 years 20 patients). Morphological and clinical manifestations characteristic of the diverticulum disease were determined by the process duration.

Relevance of the topic. Chronic radiation damage to the rectum occurs in 5-10% of patients. The development and application of a method for treating patients with post-radiation rectal injuries using autologous regenerative cells of adipose tissue in a clinic will make it possible to achieve high results in treatment. Purpose – to conduct a comparative analysis of the effectiveness of the method of microinjection autotransplantation of tissues based on immunological parameters. Patients and methods. The study involved 66 patients – women aged 28 to 83 years inclusive with complications of radiation therapy (rectovaginal fistulas, radiation proctitis, radiation ulcers). We carried out a comparative analysis of the condition of patients with post-radiation injuries before and after treatment, and also evaluated the role of microinjection autotransplantation of tissues in the treatment of post-radiation injuries of the rectum. The results and effectiveness of treatment were judged by changes in the main immunological parameters. Results. Our results indicate the high efficiency of the method of microinjection autotransplantation of adipose tissue in the treatment of post-radiation damage to the rectum. Impaired repair of damaged tissue in patients with post-radiation damage to the rectum is accompanied by changes in the T-cell level of immunity and an imbalance of pro- and anti-inflammatory cytokines, which leads to a decrease in reparation capabilities, prolonged non-healing of the defect, and progression of the disease. The revealed changes in cellular immunity and cytokine profile are mutually aggravating. At the same time, the use of SVF makes it possible to normalize these indicators, and, accordingly, allows achieving sustainable results in treatment, reducing the risk of complications, and preventing the likelihood of relapses. All this will allow in a short time to objectively assess the somatic status of the patient, the degree of operational risk, choose the most adequate treatment tactics, predict the outcome of treatment in each specific case, and will also give high clinical results (elimination of inflammation, epithelialization of the defect), and will improve the quality of life of patients. Conclusion. The use of SVF will not only eliminate the pathology, but also prevent further relapses by stimulating the regenerative capabilities of the affected tissues, as well as by achieving an immunostimulating, anti-inflammatory effect.

Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer.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.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 (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.Систематический обзор и метаанализ по сравнительной оценке эффективности лапаротомного и минилапаротомного ушивания прободной язвы с лапароскопической санацией брюшной полости.Поиск информационной базы проведен на русском и английском языках в научной электронной библиотеке, библиотеке Кокрейновского сотрудничества и базе данных PubMed. Проанализированы оглавления профильных журналов, тематические обзоры и их библиографические ссылки. Неопубликованные сведения получены в ходе личных контактов с руководителями российских хирургических клиник. Для расчетов метаанализа использована программа RevMan 5.3.Мировых рандомизированных исследований в доступной литературе не выявлено. Метаанализ проведен по результатам российских нерандомизированных исследований. Общий материал включил 1177 наблюдений. В 43% случаев (Метаанализ указывает на преимущество лапароскопически ассистированного ушивания прободной язвы из минидоступа над лапаротомным. Фактором, компрометирующим полученные результаты, является отсутствие стандартизованного подхода при выборе между минилапаротомным и лапаротомным методом оперативного вмешательства.

This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.

The authors' opinion about conservative treatment of acute appendicitis is presented in the article. Conservative treatment of acute appendicitiswas proposed by K. Varadhan, etc. (2009). It was presented the examination results of 7216 patients who werehospitalized with suspected acute appendicitis. Also it was analyzed the results of appendectomy, which were performed in 5172 patients. Validity of diagnostic laparoscopy, informational content of ultrasonic scanning and Alvarado scale were discussed in the article. The authors propose that wide application of conservative treatment of acute appendicitis is premature in Russian Federation. Technique approbation is necessary on base of several medical organizations with discussion of its results within the Russian Society of Surgeons.

An analysis of the condition of emergency surgery for the patients with acute abdominal diseases was made in the period of 1972-2012. The dynamics of surgical beds provision and surgical personnel were taken into account. The authors investigated the rate of general and postoperative lethality, tendencies and regular occurrences and leading reasons of negative results in given diseases. Reserves of further decrease of the lethality were considered and it was associated with shortening of hospitalization part later than 24 hours. The future improvement of intensive therapy and resuscitation, more wide application of minimally traumatic techniques of surgical treatment could give better results in this group of patients.

Целью исследования явился поиск критериев, на которые можно опираться при выборе сроков выполнения релапаротомиипри этапном лечение пострадавших с тяжелой травмой живота.Материалы и методы: представлены результаты эксперимента на 24 поросятах, показывающие прогрессирование ише-мии органов брюшной полости, а как следствие и рост показателей уровня лактата крови, при увеличении показателей ин-траабдоминального давления. Клинический материал состоял из 42 пострадавших с тяжелой травмой живота (среднийбалл по шкале ВПХ-СП 28,28±3,37). Клинический материал был разделен на две группы. Учитывая результаты вышеопи-санного эксперимента в качестве критериев для определения сроков выполнения релапаротомии использовались показате-ли уровня лактата крови и показатели интраабдоминального давления у 19 пострадавших основной группы. Показанием квыполнению реоперации в основной группе являлись увеличение в динамике или сохранение интраабдоминального давленияна уровне 20 мм рт. ст. и выше, а показателя уровня лактата крови на уровне 7 ммоль/л и выше в течение 12 часов. У 23пострадавших контрольной группы релапаротомия откладывалась до полной стабилизации состояния.Результаты и их обсуждение Из 42 пострадавших всего клинического материала после повторной операции умерло 20(47,6%) пострадавших. Из них в основной группе умерло 6 (31,6%), а группе контроля 14 (60,9%) пострадавших (φ=1,926,р

Ethiology, pathogenesis, treatment and prevention of reperfusion disorders in emergency abdominal surgery are highlighted in the article. The thorough analysis of reperfusional disorders' pathogenesis by the abdominal compartment syndrome was carried out.

The presented method of hernioplasty was used in 1242 patients with different types of inguinal hernias. In 428 patients plasty of the inguinal canal was performed by the classical method of Lichtenstein, in 814 patients the method was modified. The method modified by the authors is described in detail. Improved results of treatment are associated by the authors with reduced ischemization of the sutured tissues with reticulate endoprosthesis. Recurrent hernias were noted in 0.2% in the main group, and 1.8% in the control group.

Results of surgical treatment of 197 patients with acute colonic obstruction complicated by intraabdominal hypertension were analyzed. Monitoring of intraabdominal pressure was made in 101 patients at the pre- and postoperative periods. Compensated, sub- and decompensated forms of obstruction depending on the data of intraabdominal pressure were determined. The level and dynamics of the intraabdominal pressure are taken as criteria of severity of acute colonic obstruction, decision on the time and volume of surgical procedures. The medico-diagnostic algorithm of management of such patients is proposed. Lethality turned out to be decreased to 15.8% as compared with a control group (24%) due to the monitoring of intraabdominal pressure and improved surgical strategy.

The authors present results of examination and treatment of 698 patients with erosive-ulcerative lesions in the mucous membrane of the upper digestive tract that accounted for 39.49% of all subjects with gastrointestinal hemorrhage. These lesions were diagnosed in 73.8% of the patients in critical conditions. The leading role in their pathogenesis is played by ischemic-perfusion syndrome, gastric acid hypersecretion resulting in microcirculatory disorders, hypoxia, and activation of free radicals in gastric and duodenal mucosa. It is concluded that preventive and conservative therapy of the above lesions must be focused on the correction of ischemia and after-effects of reperfusion to achieve long-standing hypoacidic state (pH4) with the help of up-to-date antisecretory agents.

Retrospective analysis of treatment results was carried out in patients with acute bleedings from upper digestive tract according to efficacy evaluation of hemostatic methods. All methods of hemostasis were divided into 7 groups: resectional, local treatment of the bleeding source with or without vagotomy, angiosurgical, local surgical hemostasis, hemostasis along the length, endoscopic hemostasis and conservative modes. Indications for hemostatic methods were estimated depending on severity, intensity, character of the bleeding basing on the J. Forrest classification and severity of patient's condition (severity of blood loss). Prophylactic measures for prevention of recurrent bleedings after primary hemostasis are proposed. Differential approach to hemostasis in acute gastrointestinal bleedings allows achieving 96-97% efficacy.

Results of treatment of 345 patients with Mallory-Weiss syndrome were analyzed. Classification of the disease with a glance on stages and bleeding activity was given. Methods of hemostasis and indications for the surgical interference were discussed. The importance of consideration and respective treatment of the concomitant gastrointestinal diseases or alcohol intoxication was stressed.

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 measurement and monitoring of intraabdominal pressure at 288 patients treated for different abdominal diseases and trauma were analyzed. In early postoperative period the increase intraabdominal pressure to 10-15 mm Hg (I degree) was revealed at 161 (56.0%) patients, from 16 to 25 mm Hg (II degree)--at 95 (33.0%), from 25 to 35 mm Hg (III degree)--at 23 (8.0%), more 35 mm Hg (IV degree)--at 8 (2.7%) patients. When intraabdominal pressure decreased on 4-5 mm per day the prognosis was positive at 257 (89.2%) operated patients. Critical type regarded as compartment syndrome (III-IV degree) was diagnosed at 31 (10.8%) patients. Relaparotomy was performed at 23 (8.0%) patients with III degree hypertension, the lethal outcome was at 6 (26.1%) cases. Relaparotomy at 8 (2.7%) patients with IV degree hypertension was late, and all the outcomes at these patients were lethal. General lethality at compartment syndrome was 45.2%. It is concluded that monitoring of intraabdominal hypertension should be mandatory diagnostic method, and critical parameters of abdominal hypertension--absolute indication to repeated laparotomy and decompression of abdominal cavity.

Based on an analysis of case histories of 45 patients with destructive pancreatitis and coexisting peritonitis the authors have proposed a score assessment of the disease severity. It is based on accounting the morphological alterations in the pancreas and retroperitoneal fat, statistical data from case histories of the patients. This method of assessing the severity of acute pancreatitis is good for specification of the management of the patient in the hospital and for a retrospective analysis of the case history.

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.

Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.

Bashkirsky State Medical University served as an example for evaluating role of higher education institution in development of medical staffers in the region and their health care.

Criteria of laparoscopic approaches are substantiated. Advantage of combined procedures in difficult surgeries is proved. Microcirculation of the peritoneum and influence of different surgical approaches on it were studied. Minimal influence of minimally-invasive procedures on microcirculation is demonstrated.

Results of treatment of postcolostomy patients are analyzed. In 74.7% cases colostoma was created due to tumor of the rectum or colon, in 6.5% -- due to diverticulosis, in 3.5% -- due to nonspecific ulcerative colitis, Krohn's and other diseases. Complications were diagnosed in 15.2% patients. Surgical treatment was carried out in 714 (43.6%) patients, 568 (79.5%) of them underwent reconstructive surgeries, 146 (20.4%) were operated for stoma complications. New methods of rectal stump preparation for surgery were used: method of differentiation of rectal stump and urether during surgeries, methods of delayed anastomosis. Laparoscopic mobilization of the colon during reconstructive surgeries led to a decrease of surgical trauma and number of complications.