[Gastric cancer complicated by bleeding. (A systematic review)]. / Rak zheludka, oslozhnennyi krovotecheniem. (Sistematicheskii obzor literatury).

Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.

[Gastric cancer complicated by bleeding: a systematic review]. / Rak zheludka, oslozhnennyi krovotecheniem.

Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.

[Features of diagnosis and treatment of elderly and senile patients with adhesive small bowel obstruction.]

Adhesive small bowel obstruction is a common pathology with a tendency to increase characterized by a complex pathogenetic course with a high percentage of complications and deaths. Among the forms of intestinal obstruction caused by mechanical obstacles acute small bowel obstruction ranges from 64,3 to 80% with a mortality rate of 5,1 to 8,4% in the structure of urgent diseases. The complexity of early diagnosis along with an erased clinical picture severe course against a burdened background as well as age - in elderly and senile people leads to the search for new optimized treatment and diagnostic protocols. The purpose of this study was to study the nature of the course of adhesive small bowel obstruction in elderly and senile people to establish the information content of various diagnostic methods to determine the indications for the choice of the optimal period and method of treatment. A comparative analysis of 191 patients aged 60 to 90 years and older who received treatment in the surgical departments of St. Elizabeth Hospital (St. Petersburg) in the period from 2016-2019 was carried out. All patients were divided into 2 groups: the main group consisted of 106 patients (2018-2019) the comparison group included 85 patients (2016-2017). All patients of the main group used an improved diagnostic and treatment algorithm with the use of an original point-assessment scale which made it possible to optimize diagnostics and improve treatment results. Patients in the comparison group were examined in accordance with standard protocols and surgical treatment was carried out exclusively by traditional methods. The use of the proposed therapeutic and diagnostic algorithm made it possible to increase the probability of conservative resolution of acute adhesive small bowel obstruction from 20% (17) to 33% (35) and to reduce the incidence of postoperative complications from 60,2% (41) to 25,3% (18), p<0,01, and the mortality rate from 23,5% (16) to 7% (5), p<0,05.

[Surgical treatment strategy for common peritonitis in the elderly patients.]

Despite the obvious progress in the treatment of secondary peritonitis common forms, the results are far from satisfactory, especially among patients of older age groups. In some cases, a single surgical intervention is not enough for a complete elimination of the intra-abdominal infection source, which leads to repeated sanitation interventions, the order and timing of which are currently not strictly regulated. The effectiveness of the treatment algorithm, which considers a differentiated approach to planned surgical interventions in a short time in patients with severe pathomorphological changes in the abdominal cavity, was studied. The results of treatment using planned sanitation interventions demonstrated the effectiveness of the developed algorithm, allowing to reduce the overall postoperative mortality by reducing the proportion of abdominal sepsis in the structure of adverse outcomes.

[Strategy of surgical treatment of strangulated inguinal hernias in elderly and senile age.]

We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.

[Closed abdominal injury with liver damage].

An analysis of the treatment results was made in 447 patients with closed abdominal injury combined with liver damage. An individualized treatment-and-diagnostic program considering the data of field surgery--MT scale was applied in victims with closed abdominal trauma with liver damage. At the same time the classification E. Moore et. all (1990) for liver injuries was used for assistance. The indications for endovideosurgical homeosta- sis, a primary suture of liver wound and the hepatic resection were determined. The indications for packing the liver wound were specialized using strategy of "Damage control". An appli- cation of given individualized surgical strategy allowed reduction of the lethality level from 32.3% to 17.1% in the case of closed abdominal trauma with liver damage.