[A personalized approach to recurrent abdominal pain syndrome based on clinical and laboratory algorithms]. / Personalizirovannyi podkhod k patsientam s retsidiviruyushchim abdominal'nym bolevym sindromom na osnove sozdaniya algoritmov kliniko-laboratornykh obsledovanii.

OBJECTIVE: To optimize the diagnosis of abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis via algorithms for clinical and laboratory examination. MATERIAL AND METHODS: We have retrospectively and prospectively analyzed patients with abdominal pain syndrome. We selected all patients with acute pancreatitis who repeatedly applied with abdominal pain syndrome to polyclinics and hospitals between 2017 and 2021. A personalized algorithm for patients with abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis has been developed. This algorithm underlies an information system for decision-making support. RESULTS: An optimal diagnostic algorithm is needed in reception departments of hospitals and polyclinics. This one depends on equipment of hospitals and needs to be constantly improved. When refusing hospitalization and discharging patients with recurrent pain syndromes, physicians should orient the doctors of general network to use more informative methods. Indeed, the last ones may be unavailable in reception departments and various districts due to technical, qualification and organizational shortcomings. CONCLUSION: Advanced clinical and laboratory diagnostic methods based on the above-described algorithm are necessary for recurrent abdominal pain syndrome occurring under the «mask¼ of acute pancreatitis.

[Retrograde colangiopancreatography (RCG) and endoscopic papillosphincterography (EPG) in new scheme of endosurgical strategy of treatment of cholecystitis accompanied by bilirubinemia].

The article is devoted to the substantiation of strategy changes in acute cholecystitis and the bilirubinemia of obscure etiology. At the first stage the treatment was started from RCG in 120 patients and RCG with EPG in 232 patients. The results obtained were not very good, there being many organizational problems. At the second stage the laparoscopic cholecystectomy with drainage of the common bile duct (228 patients) were performed in 248 patients with acute cholecystitis and increased bilirubin from 29.54 till 167.16 millimole/l. Futhermore, the postoperative transdrainage cholangiography was made in 184 (74.2%) patients, the stones or the obstruction of bile secretion weren't found. The classical intervention on common bile duct was required only to 4 patients, for the rest EPG was performed according to the indications. EPG was the most effective and the results were the best.

[Diagnostics of non-erosive gastroesophageal reflux disease with the use of new digital endoscopic techniques].

As gastroesophageal reflux disease is a "disease of the XXI century", the relevance of its diagnosis at early stages is high. Using transnasal esophagogastroduodenoscopy, which is significantly better tolerated by patients, and the technology of intelligent color coding of pathology of the mucous membrane FICE, can diagnose the earliest manifestations of GERD in the form of inflammatory noerosive changes in the mucous membrane of the distal esophagus, to evaluate the failure of the lower esophageal sphincter; to make a prognosis for the disease, and to formulate a rational policy of conducting the patient.

[Application of miniinvasive surgical plasty in the patients with umbilical hernia].

The investigation is devoted to improvement of surgical plasty in umbilical hernia. There were studied up the results of operations using classical and proposed miniinasive methods. New methods consisted of constricting suturing of umbilical ring in the hernial aperture diameter less than 2 cm and from 2 to 5 cm, using mini-accesses, establishment of the net implant, fixed with the sutures behind posterior sheets of rectal abdominal muscles. Best results were achieved using new methods.

[Surgical tactics in patients with cholecystitis complicated by bilirubinemia].

Basing on experience of treatment of more than 11 000 patients there were analyzed its results in 248, who were admitted to the hospital in emergency for an acute cholecystitis and raising of a bilirubin level from 29.54 to 167.16 micromol/l. Miniinvasive tactic was applied, surgical treatment was divided on the stages: laparoscopic cholecystectomy with the common biliary duct (CBD) draining, postoperative transdrainage cholangiography (in 184 patients any calculi or other obstacles to the bile outflow were not revealed), endoscopic papillosphincterotomy--in accordance with the indications established. An acute intervention on CBD using miniaccess was needed in 4 patients only. The results were estimated as good and excellent.

[The professional "burning out" among surgeons].

The issue highlights the problem of the professional "burning out" among surgeons. 95 surgeons answered the questionnary, which showed that such factors as high work load, night duties, working on a week-end, increasing number of patients for the one doctor, scarce moral and material reward for the work, unsatisfactory supply of hospitals etc., arise negative emotions in 50-100% of respontents. Possible ways to change the situation can be: preliminary interviewing of matriculants, preparing medical students for surgical realities and establishing the staff psychologist.

[Prevention of eventration in diffuse suppurative processes in small pelvis].

The study was devoted to the problem of postoperative eventrations in gynaecological practice. Coaptation removable sutures were applied in order to prevent similar complications. Operations were performed in the cases of desolate condition of purulent disease of the uterus and uterine appendages with diffuse suppurative peritonitis. An advanced operative technique of suturing through all layers of abdominal wall demonstrated its high efficacy. No one patient (from 39) had the eventration or wound abscess.

[Immediate and long-term endoscopic results of surgical treatment of gastroesophageal reflux disease].

Since is a "disease of the XXI century", the actual of its diagnostics at early stages is high. Using, which is significantly better endurance by patients and technology of intellectual colors coding of pathology of the mucous membrane FICE, can diagnose the earliest symptoms of GERD in the form of inflammatory noerosive changes in the mucous membrane of the distal esophagus, to velue insufficiency of the lower esophageal sphincter; to make prognosis for the diseas, and formulate a rational tactics of conducting the patient.

[Transnasal esophagogastroduodenoscopy and color coding system of intellectual pathology of the mucous membrane in the diagnosis of gastroesophageal reflux disease].

As gastroesophageal reflux disease is a "disease of the XXI century", the relevance of its diagnosis at early stages is high. Using transnasal fibroesophagogastroduodenoscopy, which is significantly better tolerated by patients, and the technology of intelligent color coding of pathology of the mucous membrane FICE, can diagnose the earliest manifestations of GERD in the form of inflammatory noerosive changes in the mucous membrane of the distal esophagus, to evaluate the failure of the lower esophageal sphincter; to make a prognosis for the disease, and to formulate a rational policy of conducting the patient.

[Prophylaxis of recurrences in herniotomy with P-like suture]. / Profilaktika retsidivov pri gryzhesechenii primeneniem P-obraznogo shva.

Rate of recurrences of hernias reaches 6%. Dislocation of elements of spermatic cord promotes hernia recurrence. Dislocation of membranes was studied on cadavers and during operations, and also after Postempsky's plastic surgery with additional [symbol: see text]-suture, which divides ostium and cord into three equal parts. Dislocation decreases 3-fold. 42 men were operated with [symbol: see text]-suture, there were no recurrences during 4 years of follow-up.

[Ten simultaneous operations in one patient]. / Desiat' simul'tannykh operatsii u odnoi patsientki.

In a patient, a woman of 62 years, one surgical team has performed consecutively over 3 h 45 min 10 operations for different diseases: extirpation of the uterus with appendages, removal of retroperitoneal fibrosarcoma, appendectomy, 30 cm-resection of the small intestine, polypectomy from the rectum, creation of sygmorectoanastomosis, plastic reconstruction of postoperative ventral hernia with duplication, sectoral resection of mammary gland, removal of papilloma and lipoma of abdominal wall. The outcome is favorable.

[An epidemiological analysis of postoperative suppurative pathology in surgical hospitals]. / O épidemiologicheskom analize posleoperatsionnoi gnoinoi patologii v khirurgicheskikh statsionarakh.

Approaches to the epidemiological analysis of postoperative wound complications in surgical hospitals are summarized. The indices for the evaluation of the epidemic situation in surgical departments (the ratio of severe and mild forms of complications, severe and posthospital complications) are proposed. To determine the site of infection, the method of graphic analysis, involving the fixation of dates of the operation and the appearance of the complication and taking into account regularities in the development of the outbreak, the depth and severity of the lesion, is proposed. Epidemiological surveillance at medical institutions permits the prognostication of the epidemiological situation. The realization of epidemiological surveillance at the level of individual medical institutions is the prerequisite of effective functioning of the program of epidemiological surveillance at a given territory.

[Gallstone ileus]. / Zhelchnokamennaia kishechnaia neprokhodimost'.

The authors discuss 25 patients with gallstone ileus, which is a quite frequently encountered complication of cholelithiasis and is recorded in 0.64% of patient who underwent operation for calculous cholecystitis. The diagnosis and treatment of this complication have some specific features whose knowledge is extremely important in rendering emergency surgical care. Better results can be achieved by a timely and adequate diagnosis, individual choice of the operative method, and subsequent follow-up of the patients who were operated on. Regular medical examination and planned preventive treatment of patients with cholelithiasis are the main trends in the prophylaxis of this disease. Postoperative mortality was 24%.

[Surgical tactics in acute cholecystitis]. / Khirurgicheskaia taktika pri ostrom kholetsistite.

The results of treatment of 1,843 patients with acute cholecystitis are analysed. Operations were carried out on 766 patients, postoperative lethality 3.5%. A more active surgical tactics was accepted in the last 3 years, as the result of which postoperative lethality fell to 1.2% in 1988. Cholecystostomy was conducted under local anesthesia in patients who were in a grave condition, and in elderly and old--aged patients with an operative risk. The authors analyse 71 cases in which the late-term results were studied, they proved to be good on the main.

[Various problems of epidemiology and prevention of suppurative-inflammatory complications in surgery]. / Nekotorye voprosy épidemiologii i profilaktiki gnoino-vospalitel'nykh oslozhnenii v khirurgii.

An epidemiological analysis of pyo-inflammatory diseases (PID) in surgical department of multiprofile hospitals has been made. PIDs were diagnozed in 16.2% of patients operated upon. The observation of fluctuations of the level of PID with regard for the correlation of severe and "minor" forms and terms of their appearance allows to make a conclusion of the probable place of infection and may serve an indicator of epidemiological situation. The application of film-forming drug "Lyfuzol" for closing operative wounds has decreased the incidence of PID in catarrhal and phlegmonous appendicitis 2.6 times.