[Consequences of the COVID-19 pandemic for surgical service]. / Posledstviya pandemii COVID-19 dlya khirurgicheskoi sluzhby.

The COVID-19 pandemic has a serious impact on surgical service, emergency and especially elective surgical care. Many hospitals were re-designated as COVID hospitals due to resource constraints and large number of COVID-19 patients requiring hospitalization. This led to cancellation or postponement of scheduled surgeries. In addition, restrictions in elective surgery were associated with the risk of infection in surgical patients. Various protocols and guidelines recommended non-surgical or outpatient treatment if possible. During the pandemic, postoperative morbidity and mortality in emergency surgery increased significantly. The same is true for elective surgeries in 7-8 weeks after previous coronavirus infection. The authors analyze the issues of organization, priorities for restoration of elective surgery and criteria for patient selection.

[Laparoscopic versus laparoscopy-assisted suturing of perforated peptic ulcers (meta-analysis)]. / Laparoskopicheskoe i laparoskopicheski assistirovannoe ushivanie probodnoi yazvy (metaanaliz).

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.

[Drug treatment of coronavirus disease COVID-19: evidence exists?] / Medikamentoznoe lechenie koronavirusnoi bolezni COVID-19: sushchestvuet li dokazatel'naya baza?

The article provides a review of foreign literature for 2020 on existing methods of drug treatment of coronavirus disease COVID-19. To date, in the treatment of COVID-19 in different countries, a little more than 10 drugs are used. The largest number of studies on the testing of these drugs is carried out by scientists from China, the USA, and European countries. It should be noted that among these drugs there is not a single new drug developed specifically for the treatment of COVID-19, the recommended and used drugs have previously been used to treat, as a rule, diseases of the viral etiology, less often another pathology. These suggestions are often based on analogy, the hypothesis of their supposed effectiveness for COVID-19. It can be assumed that a brake on the development of a drug specific for coronavirus disease is a poor knowledge of the pathogenesis of virus invasion in the body's adhesives and the development of complications. The review provides detailed literature data on drugs such as hydroxychloroquine / chloroquine, lopinavir/natinavir, remdesivir, ACE inhibitors and angiotensin converting enzyme receptor blockers, tissue plasminogen activator, as well as plasma transfusion transfusions.

[Classification of surgical complications]. / Klassifikatsiia khirurgicheskikh oslozhnenii (s kommentariem redkollegii).

AIM: To develop classification of surgical complications. MATERIAL AND METHODS: The most common and recently proposed classifications of surgical complications (Clavien-Dindo, Occordion, R. Satava, et al., A. Kazaryan, et al.) were analyzed. Postoperative complications in 25 556 patients were retrospectively assessed. Incidence and severity of complications, methods of their correction, effect of complications on length of hospital-stay were analyzed. RESULTS: As a result of comprehensive analysis, new classification of surgical complications was proposed. 5 grades of complications were identified. Classification is based on anatomical features, type of complications (within surgical access, organ or cavity), correction depending on this type, severity of complications. Causal relationship of complication with type of repair and increased length of hospital-stay was considered. CONCLUSION: Classification proposed is anatomically justified, considers causal relationship of complications and their repair, as well as length of hospital-stay.

[Simultaneous abdominal and retroperitoneal surgery].

AIM: To study the results of simultaneous abdominal and retroperitoneal interventions. MATERIAL AND METHODS: The article presents analysis of 856 simultaneous operations whose proportion was 3.49% of total number of operations. Most of them was performed via videolaparoscopic approach (697, 81.4%), open access and mini-laparotomy were used rarer (111, 12.9%) and 48 (6,7%) respectively). Severity of great number of interventions corresponded to degree I and II of D. Lochlein and R. Pichlmayer classification. Modern diagnostic methods including sonography, computed tomography, magnetic resonance imaging, angiography, endoscopy and laboratory data were used to define diagnosis. RESULTS: Simultaneous approach increases duration of surgery 30.3% on the average that is significant risk factor in case of surgery of severity degree III and videolaparoscopic interventions. Simultaneous surgery does not significantly increase ICU-stay and incidence of postoperative complications.

[TRAUMATIC INTRAORGANIC HEPATIC AND SPLENIC HEMATOMAS].

An analysis of application results of complex research methods of diagnostics of intraorganic hepatic and splenic hematomas was made. At the same time, options of these methods were used for determination of prescription of injury. The ultrasound, CT, MR-imaging, videolaparoscopy, angiography, Doppler ultrasonics, impedometry, biochemical, laboratory and cytological study of punctate sample from hematomas were applied for this purpose in 33 patients. According to authors, an evolution of hematomas happened in 3 stages, each of this stage was characterized by specified data associated with investigation results. The staging procedure of hematomas or their evolution allowed setting the prescription of injury.

[Surgical management of traumatic retroperitoneal hemor-rhage]. / Khirurgicheskaya taktika pri travmaticheskikh zabryushinnykh krovoizliyaniyakh.

AIM: To present the algorithm of management of victims using modern technologies including CT, laparoscopy, angiography, intraabdominal pressure monitoring, etc. MATERIAL AND METHODS: Treatment of 395 victims with traumatic retroperitoneal hemorrhage was analyzed. RESULTS: It was shown that the use of developed algorithm decreases mortality rate from 10.5 to 4.5% and postoperative complications incidence from 23 to 14.1% in reviewed patients.

[Diagnostics and treatment of the ischemic and reperfusion disorders by the intraabdominal ischemic syndrome].

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.

[Monitoring of intraabdominal pressure in colonic obstruction].

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.

[Pathogenesis, treatment, and prevention of erosive-ulcerative lesions in the mucous membrane of the upper digestive tract].

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 (pH < 4) with the help of up-to-date antisecretory agents.

[Etiology and pathogenesis of Mallory-Weiss syndrome].

Treatment results of 405 patients with Mallory-Weiss syndrome, X-ray gastric investigation in patients with severe bloating reflex were analyzed. Experimental part of the study involved rats and pigs, modeling esophageal and gastric rupture. Cardioesophageal and gastric cardial rupture happen in case of simultaneous sudden intragastric and intraabdominal hypertension, following the rule of Laplace.

[Hemostasis in acute gastrointestinal bleeding].

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.

[The treatment of patients with Mallory-Weiss syndrome].

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.

[Syndrome of intracavitary hypertension in a surgical clinic].

The problem of intracavitary hypertension syndromes characterized by similar pathophysiological abnormalities and different etiological factors is investigated and discussed. Compartment syndrome is believed to be the extreme variant of the disease. Specific markers and methods of correction (including surgical intervention) of intracavitory hypertension in critical situations are considered.

[Abdominal compartment syndrome in urgent surgery].

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.

[Feasibility of correction of insulin insufficiency after autotransplantation of splenic tissue in duodenopancreatectomy].

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.