[EFFICIENCY "SLEEVE" GASTRECTOMY IN TREATMENT OF OBESITY].

The possible mechanisms of clinical efficacy "sleeve" gastrectomy in patients with obe- sity were analysed. The metabolic effect transactions associated not only with reducing the volume of the stomach, but the acceleration passage of gastric contents of the tube and the small intestinp_

[The factor of intra-abdominal pressure in patients with morbid obesity].

Pathogenetic peculiarities of chronic intraabdominal hypertension syndrome (CHIHS) in patients, suffering morbid obesity (MO), to whom bariatric operative interventions were performed, were studied. The intraabdominal pressure factor impact on the concurrent diseases and postoperative period course in patients, suffering MO, was analyzed.

[Biliopancreatic shunting with duodenal switch in patients suffering morbid obesity: first clinical experience].

In 2009 in the clinic a biliopancreatic shunting operation with duodenal switch was performed in accordance to D. Hess-P. Marceau method in 26 patients, suffering morbid obesity. First clinical results of operative intervention (the fixed terms of follow-up for 6 months after the operation) were studied in 15 patients. The main complications, the impact of operative intervention on the course of comorbidities, associated with obesity, diseases and metabolic disorders, were analyzed.

[Estimation of possibilities and methods of operative intervention in complicated tumors of the right colonic flexura].

Experience of surgical treatment of 11 patients, suffering locally-advanced cancer of right colon without remote metastases, was analyzed. In all the patients various variants of extended right-sided hemicolectomy with adjacent organs resection were applied, Surgical tactics in advanced cancer of right colon was substantiated and detailed. The results of investigation conducted witness the trustworthiness of individualized approach application for operative intervention variant choice in patients, suffering locally-advanced complicated cancer of right colon, promoting the results of surgical treatment improvement.

[Symptomatic laser endoscopic recanalization in inoperable esophageal cancer].

The results of clinical usage of conventional and original methods of laser endoscopic recanalization in patients with inoperable esophageal cancer were analyzed. It was established, that application of modifications, elaborated in the clinic--combined laser endoscopic recanalization with bougienage and without it have permitted to raise essentially a rate of the complete esophageal recanalization achievement, to reduce a quantity of the procedures needed to restore the tumoral stenotic region passability and to reduce a recanalization course duration.

[Clinico-endoscopic peculiarities of gastric ulcer of type I and II].

A detailed analysis of clinico-endoscopic peculiarities of gastric ulcer type I and II was presented. The peculiarities of a clinical course and the complications character of differently localized gastric ulcers were determined. There was shown the connection between concomitant disorders of esophagogastroduodenal motor-evacuation function and gastric ulcer localization and type. While tactics of treatment and operative procedure choosing it is mandatory to take into account the clinical course peculiarities and the results of endoscopic investigation.

[Estimation of postoperative morphological changes in the area of a potential formation of colorectal anastomosis in experiment].

In experiment on 50 white mongrel male rats there were investigated postoperative morphological changes in the area of a potential formation of colorectal anastomosis, occurring after total rectal mobilization performance. There was established, that rectal mobilization, even while securing a blood flow along the main vessels, causes nonreversible ischemic disorders in its wall. The investigation results witness the enhanced risk of the sutures insufficiency occurrence in low colorectal anastomoses and substantiate the expediency of application of prophylactic methods for this complication in a clinical practice.

[Experimental investigation of intra-abdominal pressure influence on multiple organ insufficiency and bacterial translocation].

The influence of intraabdominal hypertension on polyorgan insufficiency and bacterial translocation formation was studied in experiment on 40 white male rats owing mass about 250-300 g. Intraabdominal pressure (IAP) raising in the rats causes abdominal ischemia and consequent early changes in anterior abdominal wall muscles, small intestine and large bowel, kidneys, spleen, liver, and bacterial.translocation as well. The results of investigation trusts the necessity of monitoring and IAP effective control conduction in surgical patients.

[Effect of intra-abdominal pressure factor and early enteral nutrition on postoperative period course in patients with pylorostenosis].

The results of surgical treatment of 32 patients, suffering gastric cancer with the stomach outlet stenosis, were analyzed. There was established a negative reverse interrelationship existing between intraabdominal pressure level (IPL) and the patients tolerance to the enteral feeding conduction. The disorder of tolerance to early enteral probe feeding (EEPF) conduction postoperatively owes a prognostic significance in this group of patients. The IPL monitoring conduction in this group of patients permits to optimize the EEPF conduction and has a prognostic significance for postoperative period course.

[Progressive pneumoperitoneum technique in surgical treatment of patients with giant defects of the abdominal wall].

The experience of treatment of 52 patients suffering cardial and pulmonary insufficiency with giant defects of abdominal wall was summarized. 25 of them were preparative for operative treatment using of progressive pneumoperitoneum techniqueand 27 were treated without special preoperative preparation. Preoperative progressive pneumoperitoneum as a first stage of treatment of such patients significantly decrease early postoperative morbidity rate.

[Interpretation of recommendations of European Association of Herniologists for the problems of inguinal hernia treatment].

The interpretation of the main rules of the European Association of Herniologists (EAH) and the materials of the Fourth International Congress of Herniologists in Berlin (9-12th of September 2009) is adduced, taking into account the views of clinic, owing experience of treatment of 2500 patients, suffering inguinal hernia. The recommendations proposed have a chance to become a basement document for doing correction and standardization of protocols for medical staff training and the national standards elaboration concerning inguinal hernias treatment. Their overview and putting changes into them are planned for 2012 yr., and their discrete annual correction would take place, taking into account the proving base modernization, all of them in a frames of EAH congresses.

[Modern approaches for the choice of open-access method of plastic surgery for recurrent inguinal hernia].

Retrospective analysis of the treatment results concerning 272 patients, who have suffered recurrent inguinal hernia and were operated on in the clinic for the period of 1999-2009 yrs, was done. The need for preperitoneal plasty of inguinal canal performance for recurrent inguinal hernia, using extrainguinial access to hernia defect, was noted. This procedure lowers therisk of iatrogenic injury occurrence of anatomic structures of inguinal canal.

[Application of antihomotoxic preparations in complex treatment of early inflammatory complications, occurring after gastrointestinal operations].

Anastomositis and abdominal cavity infiltrate constitutes the most frequent early inflammatory complications, occurring after gastrointestinal operations. The informativity of diagnostic methods of these complications, the volume and efficacy of conservative curative procedures were shown. Introduction of antihomotoxic preparations in complex of treatment measures, in part, of Traumeel C, Lymphomyosot, Mucosa compositum C, Echinacea compositum C had promoted the efficacy raising and the shortening of the treatment duration of these complications.

[Surgical treatment of primary multiple tumoral lesions of the large intestine].

Experience of treatment of 37 patients, suffering primarily-multiple cancer of large intestine, including 17--with synchronous and 20--metachronous tumors, and an acute obturational ileus of large intestine, is presented. There was conducted the analysis and peculiarities of surgical tactics suggested as well as various methods of such patients treatment were determined. The investigation results trust the necessity of application of individual perioperative tactics in patients, suffering primarily-multiple tumors of large intestine leading to achieve better outcomes of their surgical treatment.

[The newly occurred and recurrent gastric ulcers after organ-preserving operations for the ulcer disease].

The literature data and the results of own investigations on gastric recurrent ulcers occurrence after organpreserving operations performance for the ulcer disease are summarized. The data on gastric recurrent ulcers occurrence rate are adduced. Modern views on possible causes of occurrence, necessary volume and informativity of investigation methods and tactics of treatment are presented. Gastroduodenal motor-evacuation function disorders, duodenogastric reflux and gastric hypersecretion are suggested as a most frequent causes of gastric recurrent ulcers occurrence. The method of operative intervention choice for recurrent gastric ulcer is determined by the cause of its occurrence, as well as the character of ulcer complication and the kind of previous surgical procedure performed.

[Shunting esophagocolonoplasty in the treatment of postburn cicatricial esophageal stricture].

The prospective analysis of the results of treatment of postburn cicatricial esophageal stricture (PCES) in 338 (32%) patients, using shunting retrosternal esophagocolonoplasty (SRECP), constituting 76.1% of esophagoplasties performed, was conducted. Postoperative mortality was 4.7% (16 patients died). Early postoperative complications had occurred in 116 (34.5%) patients and the late--in 68 (24.9%). SRECP constitutes the method of first choice in patients, suffering tubular PCES and in formation of fistula, diverticulum and false ways. The standard variant of the procedure includes the performance of wide one-raw esophago-colonoanastomosis in end-to-end fashion with isoperistaltic passage of transplant. Such a tactic owes significant advantages, such as the lower risk of specific severe early and late postoperative complications occurrence, and also secures the esophagoplasty functional adequacy.