Laparoscopy is increasingly used in emergency surgery, demonstrating several advantages over open interventions. MATERIAL AND METHODS:A systematic literature review for 2018-2023 was performed, searching PubMed, MEDLINE, RSCI, CyberLeninka databases. 33 studies on the use of laparoscopy in acute surgical abdominal diseases were selected. RESULTS:The most convincing data have been obtained regarding laparoscopic treatment of acute appendicitis, cholecystitis, and gynecological pathology. There is a growing number of studies confirming the effectiveness of laparoscopy in intestinal obstruction, perforated ulcers, and abdominal trauma. Numerous publications indicate a reduction in the complication rate, decreased pain, shortened treatment and rehabilitation time after laparoscopic surgeries compared to open ones. At the same time, insufficient integration of the method into practice, lack of clear patient selection criteria, and the need for further standardization are noted. CONCLUSION:Laparoscopy should be considered as the method of choice in many urgent surgical conditions; however, further study and development of uniform protocols are required for wider implementation into the routine practice of emergency surgery.

OBJECTIVE:To study several non-respiratory lung functions in conjunction with the respiratory component in acute abdominal diseases with different natures of the inflammatory process; to identify the key mechanisms of organ damage; and, based on the data, establish a new syndrome in urgent surgery-pulmonary distress syndrome-and evaluate the effectiveness of Remaxol in its treatment. MATERIAL AND METHODS:Chronic experiments have been done on dogs. Under anesthesia, progressive acute peritonitis was simulated in the first group (24) (the first subgroup (12) received infusion therapy, the second subgroup (12) received Remaxol (20 mL/kg)), in the second group (8) acute destructive pancreatitis, in the third group (8) acute obstructive ileus. The treatment outcomes of 78 patients with acute surgical pathology of the abdomen were analyzed: 38 patients with acute peritonitis caused by destructive appendicitis, hollow viscus perforation (the first subgroup (16) received standard of care, in the second (22) Remaxol was added to the standard of care); 18 with acute severe pancreatitis complicated by enzymatic peritonitis, 22 with acute intestinal obstruction. Surgeries were performed on all the patients. The extension and type of the surgeries depended on the condition. In the early postoperative period (up to 5 days), several indicators of respiratory lung function were evaluated in the experiment and patients, and non-respiratory function was assessed using several indicators of arterial and venous blood. In the experiment, the state of lipid metabolism and the hemostasis system was assessed in lung tissues. RESULTS:It was established that in acute abdominal diseases, lung damage occurs regardless of the nature of the inflammatory process. It manifested not only with changes in the homeostasis indicators due to modifications of the respiratory component but also non-respiratory functions of the organ. It was shown that the signs of the non-respiratory dysfunction of the lungs, as indicated by the parameters of blood inflowing to the lungs and outflowing from the lungs, included a deterioration in their detoxification and lipid-modifying ability and changes in the blood coagulation system. The key and unifying feature of respiratory and non-respiratory lung damage in various types of inflammatory processes are disorders of the lipid metabolism of lung cells. In the pathogenesis of membrane destabilization, the peroxidation of membrane lipids and the high activity of phospholipases play a decisive role. In the pathological process, a certain role is assigned to the tissue (pulmonary) coagulation-lytic system. The inclusion of Remaxol in the treatment of acute peritonitis increased lung tolerance to trigger pathogenetic agents, as indicated by improved laboratory and clinical parameters. CONCLUSION:Experimental and clinical evidence was obtained for establishing the pathological condition (syndrome) in acute surgical abdominal diseases called pulmonary distress syndrome. Pulmonary distress syndrome in urgent surgery is a set of pathological processes of the body, with the most important manifestations being systemic homeostasis disorders due to lung damage as a result of alteration of membrane structures of cells resulting from hyperactivation of peroxidation and phospholipases and modifications of the tissue coagulation-lytic system, which is accompanied by deterioration of their respiratory (respiratory distress syndrome), detoxification, lipid-regulating, and hemostatic functions.

OBJECTIVE:Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction.MATERIAL AND METHODS:Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup).RESULTS:In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology.CONCLUSION:Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.

изучение выраженности эндогенной интоксикации в ранние сроки после кесарева сечения у женщин с ожирением представляет значимость для понимания и лечения данного состояния. В данной аннотации прослеживается связь между кесаревым сечением, ожирением и уровнем эндогенной интоксикации у пациенток. Исследование проведено с использованием методов анализа биохимических показателей крови и клинических симптомов у женщин, перенесших кесарево сечение. Результаты исследования указывают на увеличенный уровень эндогенной интоксикации в ранние сроки после операции у пациенток с ожирением, что может свидетельствовать о наличии возможных осложнений. Дальнейшие исследования по данной теме необходимы для разработки эффективных стратегий лечения и профилактики осложнений после кесарева сечения у женщин с ожирением. the study of the severity of endogenous intoxication in the early stages after cesarean section in obese women is important for understanding and treating this condition. This annotation traces the relationship between cesarean section, obesity and the level of endogenous intoxication in patients. The study was conducted using methods for analyzing blood biochemical parameters and clinical symptoms in women who underwent cesarean section. The results of the study indicate an increased level of endogenous intoxication in the early stages after surgery in obese patients, which may indicate the presence of possible complications. Further research on this topic is needed to develop effective strategies for the treatment and prevention of complications after cesarean section in obese women.

Background. Until now, acute peritonitis remains in the focus of attention in modern abdominal surgery, which is due to the preservation of a high level of morbidity and mortality, as well as high treatment costs. Materials and methods. 46 patients with acute appendicitis complicated by peritonitis were studied, divided into 2 groups: the first (n=28) – without concomitant diabetes mellitus; and the second (n = 18) – with diabetes mellitus (mainly of the first type). The patients were operated on: appendectomy, sanitation and drainage of the abdominal cavity were performed. Methods: assessment of the state of the hemostasis system, platelet aggregation activity, their lipid composition, the severity of oxidative processes and phospholipase activity. Follow-up period: before surgery, 2 and 5 days after surgery. Results. It was found that in acute peritonitis, there was an increase in the level of diene conjugates and malondialdehyde in the blood plasma at the observation stages by 70.8, 54.2 and 98.6, 82.3% (р < 0.05), a decrease in the activity of superoxide dismutase by 37.5 and 33.1% (р < 0.05), an increase in the activity of phospholipase A2 by 141.7 and 44.8% (р < 0.05). During hospitalization of patients to the clinic, an increase in the content of cholesterol esters, cholesterol, triglycerides in platelets was noted by 13.9, 13.6, 20.9% (р < 0.05), respectively. An increase in the degree of platelet aggregation was revealed by 18.3% (р < 0.05). Coagulation time was reduced by 21.1% (р < 0.05), clot formation – by 22.4% (р < 0.05). The fibrinolysis time was prolonged by 21.2% (р < 0.05). Comparative analysis has shown that in diabetes mellitus there are large violations in the system of hemostasis and homeostasis in general. In patients of this group, the content of diene conjugates and malondialdehyde in blood plasma exceeded those of the comparison group at all stages of observation by 22.0-23.4 and 15.1-18.0% (р < 0.05), the activity of superoxide dismutase decreased by 17.1-18.3% (р < 0.05), phospholipase A2 increased by 44.8-42.5% (р < 0.05).<0.05). Changes in the lipid spectrum of platelets increased: cholesterol levels were higher by 14.7% (р < 0.05), triglycerides – by 21.2% (р < 0.05), free fatty acids – by 19.3% (р < 0.05). Comparative analysis of the hemostasis system showed that the coagulation reaction time in this group on the 2nd and 5th days decreased by 14.2 and 26.3% (р < 0.05), the time of clot formation - by 15.1 and 13.6% (р < 0.05), the percentage of lysis – by 19.4 and 12.5% (р < 0.05). Conclusions. One of the significant factors in the modulation of the hemostasis system in comorbid pathology of patients with acute peritonitis is a significant activation of trigger agents leading to oxidative stress, excessive phospholipase activity, changes in the composition of platelet lipids, hypercoagulemia, inhibition of fibrinolytic activity, microthrombosis. This is especially evident in conditions burdened with diabetes mellitus, in which the activity of hemocoagulation triggers and their effect on the hemostasis system is detected to a greater extent.

Background. A significant threat to the children health is posed by widespread forms of secondary peritonitis, which account for 16.8-42.88% of cases, and the postoperative complications frequency reaches 4%. The purpose of the study was to evaluate the empirical use effecacy of ceftriaxone, cefotaxime and amikacin in different age children with secondary widespread peritonitis. Materials and methods. In 63 children (44.4%) of different age groups with secondary widespread peritonitis, the dynamics of changes in inflammatory markers before surgery and in the early postoperative period were assessed, and a bacteriological examination of the abdominal cavity contents was carried out to identify the microflora sensitivity to ceftriaxone, cefotaxime and amikacin. Results. A conducted study of children with secondary widespread peritonitis demonstrated its highest incidence at an early age. The maximum content of inflammatory markers was determined before surgery and 1 day after surgery in all patients without exception. At the same time, at younger age groups of patients, the increase in these indicators occurred to a greater extent, and their normalization was slower, that indicated a more severe course of the purulent-inflammatory process in the abdominal cavity. Bacteriological examination of the abdominal cavity contents demonstrated the most common occurrence of E. coli (38%) both as a monovalent culture and in association with other pathogenic microorganisms. The most effective antibacterial drug was amikacin (88.2%). Ceftriaxone (79.4%) and cefotaxime (82.4%) showed less antimicrobial effect. The sensitivity lack of the microorganisms association to prescribed antibiotics was the reason for the abdominal abscesses development in 2 children in the postoperative period. Conclusion. Empirical antibacterial therapy plays an important role in the treatment of secondary widespread peritonitis. The use of amikacin as a starting antibiotic promotes the most effective effect on pathogenic microflora in secondary widespread peritonitis.

Background. Mechanical jaundice (MF) and cholangitis are considered to be of great significance in emergency surgery due to their complex pathogenesis, risk of complications and high mortality. Objective. To establish the severity of hemostatic disorders in association with fibrinogen gene polymorphism (FGB (G(-455)A)) in patients with non-cancerous MF and cholangitis of varying severity. Material and methods. The subjects were 25 patients with benign MF and cholangitis divided into 2 groups: group 1 (n=12) – those with a mild form of the disease; group 2 (n=13) – those with a severe form. The research methods included the assessment of endogenous intoxication, liver function as well as blood coagulation activity. Genetic analysis of the FGB (G(-455) geneA)) was performed using a polymerase chain reaction by Real–time PCR. The severity of the disease was determined using the V.D. Fedorov scale (2000). Results. The early stage of MF and cholangitis is accompanied by endotoxicosis, resulting in the damage of a number of organs and systems, in particular the liver. The latter plays an important role in changing the activity of blood coagulation system. These disorders had a strong correlation with the severity of the disease: in mild cases, the character was less pronounced and reversible, and in severe cases – persistent and severe. Hemostatic disorders recorded in the early period of the disease depend on the severity: in mild cases, hypercoagulation and normofibrinolysis are noted, and in severe cases – hypocoagulation and hypofibrinolysis. Genetic polymorphism of the fibrinogen gene FGB (G(-455)A) had a significant impact on the pathogenetic process of MF and cholangitis. Patients with the mutant genotype (A/A) of the FGB gene were found to show the greatest severity of homeostasis system violation when compared with patients with genotypes G/G and G/A – with minimal imbalance. Conclusions. Hemostatic disorders associated with polymorphism of the fibrinogen gene FGB (G(-455)A) play an important role in the pathogenesis of MF and cholangitis.

OBJECTIVE:To develop a highly informative method for predicting the course of early postoperative period in urgent abdominal surgery based on indicators of lipid metabolism.MATERIAL AND METHODS:We analyzed 113 patients with acute surgical abdominal disease including 56 (49.6%) ones with acute appendicitis complicated by peritonitis, 23 (20.4%) ones with acute intestinal obstruction complicated by peritonitis and 34 (30.0%) patients with acute moderate pancreatitis (early phase). Leukocyte count, malondialdehyde, medium-weight molecules and lipid composition (phospholipid lysoforms) were analyzed throughout a 5-day period. Considering these data, we developed a method for predicting the course of early postoperative period (patent).RESULTS:Original method is highly effective in predicting the course of early postoperative period in urgent abdominal diseases. Sensitivity and specificity of this method for acute abdominal diseases complicated by acute peritonitis are 94.7% and >86.3%, for acute pancreatitis - 92.7 and 85.4%, respectively.CONCLUSION:Efficacy of original method is determined by analysis of catabolic phenomena, i.e. indicators of tissue destruction. Of course, assessment of endogenous intoxication whose toxins are components of catabolic (membrane-destructive) processes is essential.

AIM OF THE STUDY. To establish the incidence of acute thrombosis of the veins of the lower extremities and the activity of the most significant trigger agents that led to this complication in patients with a new coronavirus infection. MATERIAL AND METHODS. The clinical section of the work is presented by observations of 123 patients with acute surgical pathology and thrombosis of the veins of the lower extremities. The first group (comparison) (n = 48) included patients with thrombosis of the veins of the lower extremities, the second (studied) group (n = 87) included patients with a similar problem that arose against the background of coronavirus infection. All patients underwent surgical interventions: thrombectomy and plication. Before surgery, on the 1st, 4th and 7th days after surgery, disorders of the hemostasis system, the severity of endogenous intoxication syndrome, and lipid metabolism were assessed. RESULTS. Damage to the veins of the lower extremities in patients with acute surgical pathology and new coronavirus infection occurs much more often, in 8.04 % of cases, than in such patients without COVID-19, in 0.76% (χ2 = 252.5, p < 0.001). Of the 87 patients with acute venous thrombosis of the inferior vena cava system and COVID-19, 63 patients (72.41 %) were operated on. In the early postoperative period, venous rethmbosis occurred in 11 (17.5 %) patients. The mortality rate was 6.3 %. According to thromboelastography, in the main group the values of such parameters as reactive time, the growth rate of the fibrin network and its structure formation and the maximum strength of the clot were statistically significantly higher than in the control group, which indicates the predominance of hypercoagulation in these patients. Patients in this group showed more significant phenomena of endotoxemia, oxidative stress and activation of phospholipases. CONCLUSION. With a new coronavirus infection, surgical patients have a high probability of developing threatening thrombohemorrhagic complications. The most important trigger for their occurrence is significant disturbances in the hemostatic system, which are generally characterized by an increased ability of the blood to form thrombosis against the background of a decrease in its fibrinolytic activity. Disturbances in the hemostatic system occurred against the background of oxidative stress, activation of phospholipases and endotoxemia. The obtained material is proof of the significance of the new coronavirus COVID-19 infection worsens coagulopathy, which plays an important role in the pathogenesis of the disease in general and the development of complications.

Background. Until now, urgent pathology of the abdomen remains in the focus of attention in modern abdominal surgery, which is due to the preservation of a high level of morbidity and mortality. Therefore, it is relevant to search for treatment regimens to optimize the results of treatment, especially in comorbid pathology with diabetes mellitus. The purpose of the study is to establish the effectiveness of metabolic and laser therapy in the correction of homeostasis and microcirculation disorders in the early postoperative period in patients with comorbid urgent pathology of the abdomen with diabetes mellitus. Materials and methods. 38 patients with acute abdominal diseases complicated by peritonitis and diabetes mellitus of both types were studied: the first (n=20) – treatment of patients according to clinical recommendations; the second (n=18) – complex treatment included laser therapy and remaxol. The patients have been operated on. Observation stages 1, 3 and 5 days after surgery. The microcirculation, the level of toxins, the severity of oxidative stress and the activity of phospholipase A2 were evaluated. Results. It was found that in patients who underwent surgical interventions for acute surgical pathology of the abdomen, having diabetes mellitus, significant phenomena of endogenous intoxication occurred in the early postoperative period, which was accompanied by phenomena of oxidative stress and increased phospholipase activity. Patients in the early postoperative period had significant microcirculation disorders. In the group of patients whose treatment included laser therapy and remaxol, homeostasis and microcirculation disorders were less pronounced. It turned out that the number of complications in patients who occurred in the early postoperative period, assessed according to the Clavien-Dindo classification, decreased by 34.7% (p<0.05), the stay of patients in the hospital was reduced by 2.12 bed-days (p<0.05). Conclusion. The use of laser therapy and remaxol in the complex treatment of patients with urgent abdominal diseases with diabetes mellitus has shown high efficiency. With this kind of therapy, the main pathogenetic components of the presented comorbid pathology are affected, on which the course of the early postoperative period and the development of complications directly depend.

Введение. Механическая желтуха (МЖ) и холангит считаются актуальными заболеваниями в неотложной хирургии, так как характеризуются сложным патогенезом, риском осложнений и высокой летальностью. Цель исследования – установить выраженность гемостатических расстройств в сопряженности с полиморфизмом гена фибриногена (FGB (G(-455)A)) у пациентов с неопухолевой МЖ и холангитом разной тяжести. Материал и методы. В основу положены результаты обследований 25 пациентов с доброкачественной МЖ и холангитом, разделенных на 2 группы: группа 1 (n=12) – с легкой степенью; группа 2 (n=13) с тяжелой формой. Методы исследования включили определение эндогенной интоксикации, функционального статуса печени и коагуляционной активности крови. Генетический анализ гена FGB (G(-455)A)) выполнен при помощи полимеразной цепной реакции (ПРР) методом Real-time ПЦР. Тяжесть заболевания определена по шкале В. Д. Федорова (2000). Результаты. Ранняя стадия МЖ и холангита сопровождаются эндотоксикозом, который ведет к поражению ряда органов и систем, особенно печени. Последней принадлежит важная роль в изменении активности системы свертывания крови. Данные расстройства имели сильную связь с тяжестью заболевания: при легкой степени характер был менее выраженным и обратимым, при тяжелой – стойким и тяжелым. Гемостатические нарушения, регистрируемые в раннем сроке заболеваний, находятся в зависимости от степени тяжести: при легкой форме отмечены гиперкоагуляция и нормофибринолиз, при тяжелой – гипокоагуляция и гипофибринолиз. Генетический полиморфизм гена фибриногена FGB (G(-455)A) оказал существенное влияние на патогенетический процесс МЖ и холангита. Установлено, что у пациентов с мутантным генотипом (А/А) гена FGB отмечена наибольшая выраженность нарушения системы гомеостаза при сравнении с пациентами с генотипами G/G и G/А – с минимальным дисбалансом. Выводы. Гемостатические нарушения, сопряженные с полиморфизмом гена фибриногена FGB (G(-455)A), играют существенную роль в патогенезе МЖ и холангита.

Acute pancreatitis remains one of the most dangerous pathologies in the structure of emergency abdominal surgery. This is due to many reasons, including an increase in the frequency of destructive forms of the disease, high mortality, and frequent unfavorable outcomes. The aim of this study was to investigate a number of leading components of homeostasis in patients with acute pancreatitis of varying severity. A retrospective study was conducted on 50 patients with acute pancreatitis of diff erent severity levels who were hospitalized at the Republican Clinical Hospital named after S.V. Katkovа (Saransk, Russia). The patients were divided into groups: the fi rst group (control, n = 30) consisted of patients with mild acute pancreatitis, and the second group (main, n = 20) consisted of patients with severe acute pancreatitis. The study evaluated the endogenous intoxication syndrome, the activity of lipid peroxidation and phospholipase systems, microcirculation status, liver function, and the activity of the coagulation-lytic blood system. The results showed that in the early stages of acute pancreatitis, several pathological processes were observed: the development of endotoxemia syndrome, activation of lipid peroxidation and phospholipase systems, microcirculation disorders, changes in the coagulation and fibrinolytic links of the hemostasis system, and liver function suppression. The severity of these disorders was associated with the severity of the pathology. In cases of mild severity, the changes in the parameters studied were reversible, while in severe cases they were stable and oftenirreversible. The presence of toxemia, oxidative stress, dysmicrocirculation, and hemostatic disorders should be considered as risk factors for disease progression and complications.

Background. Recently, the number of cesarean section deliveries has increased, which increases the risk of postoperative complications. One of the important risk factors is obesity, which significantly complicates the healing of laparotomy wounds. The purpose of the study was to establish a link between the degree of obesity and the presence of complications after abdominal delivery. Materials and methods. 65 pregnant women were examined after delivery by cesarean section. In accordance with the purpose of the work, three groups are identified. In the first group there were women with normal body weight, in the second group there were women with grade I obesity (body mass index over 30), in the third group there were women with grade III obesity (body mass index over 40. The obtained digital data were processed by the method of variational statistics using the Student's t criterion. Results. In obese patients, repair of abdominal wall tissue structures after cesarean section in the early postoperative period was slower and more imperfect. The analysis of the obtained cytological material showed that the course of incomplete reparative regeneration of abdominal wall tissues in obesity occurred against the background of prolongation of the inflammatory phase, revealed by the analysis of the results of cytological examination. The prolongation of the inflammatory phase, therefore, and the low rate of tissue regeneration in the wound area in obesity were indicated by a low regenerative-degenerative index, which is determined by the ratio of normal and degenerative forms of these shaped elements. Conclusions. In obese women who have undergone cesarean section delivery, the healing process of a laparotomy wound proceeds slowly, especially in the third degree. This is documented by a marked decrease in the degenerative-degenerative index, a slowdown in the transformation of polyblasts into tissue forms – precursors of connective tissue elements. One of the factors reducing the rate of tissue repair along the suture line in obese patients after cesarean section are dysmicrocirculatory phenomena, which are most pronounced in third degree obesity.

Обследованы 34 больных острым гнойным местным аппендикулярным перитонитом и 38 -острым отечным панкреатитом средней степени тяжести.Пациентам в динамике в течение 7 суток пребывания в стационаре проводилось комплексное инструментальное и лабораторное обследование.Помимо стандартных лабораторных биохимических параметров, в крови и моче по молекулярным продуктам (диеновым конъюгатам, малоновому диальдегиду) оценивали активность оксидативного стресса, по фосфолипазе А2 -активность фосфолипаз.Об уровне эндотоксемии судили по содержанию веществ средней молекулярной массы и индексу токсичности плазмы, рассчитанному по уровню общего и эффективного альбумина.Оценен ряд показателей гомеостаза и функционального состояния почек (по содержанию креатинина и мочевины, минутному диурезу, клубочковой фильтрации, уровню молекул средней массы

Background. Until now, the frequency of total mortality in Russia in acute pancreatitis (AP) remains high, amounting to 2-5 % in mild forms, and 12-75% in destructive forms. One of the reasons for this is insufficient knowledge of the pathogenetic mechanisms of OP, including in friendly diseases. The purpose of the study is to determine the features of homeostasis disorders in patients with acute pancreatitis with coronavirus infection. Material and methods. The work is based on studies of 50 patients with AP: in the first group (n = 25) – without COVID-19; the second (n = 25) – with COVID-19. Endogenous intoxication, lipid peroxidation, phospholipase activity, microcirculation and hemostasis system were evaluated. Results. In the early phase, patients with AP have significant microcirculation disorders and homeostatic changes: endogenous intoxication, oxidative stress, activation of phospholipase systems, hemostatic disorders in the form of hypercoagulemia. The presence of coronavirus infection in AP is a significant factor in the modification of these changes. An increase in endotoxemia, intensification of lipid peroxidation and phospholipase, hypocoagulemia, hypofibrinolysis have been recorded. In patients of the first group, the number of estimated severity scores on the ARASNE II scale decreased in dynamics and by the 7th day was 4.6 ± 0.3, while in the second group it remained high was 7.8 ± 0.4 points (p < 0.05). The presence of coronavirus infection is also the cause of complications (higher by 28.5 %). Conclusion. In patients with AP and coronavirus infection, the phenomena of endotoxemia, oxidative stress, phospholipase activity, microcirculatory disorders, changes in the homeostasis system are more pronounced. Undoubtedly, this is the most important factor in maintaining the severity of the disease and the development of complications.

The purpose of this review is to study the topical issues related to using laparoscopic interventions for inflammatory diseases in the abdominal cavity (peritonitis). The features of the mechanisms of changes in the peritoneum, which is an organ of the immune system, are discussed in case of surgical trauma of the peritoneum, pneumoperitoneum, minimal invasiveness of laparoscopy compared to traditional operations is shown. The indications and existing algorithms for laparoscopic treatment of diffuse peritonitis are considered. Today, despite the development of minimally invasive surgery as a high-tech technology, the effectiveness and safety of laparoscopy in uncomplicated inflammatory diseases in the abdominal cavity has been determined, while in disseminated forms the issue continues to be discussed and requires further fundamental experimental and clinical studies with a good evidence database.

The OBJECTIVE was to study the process of wound healing after surgical interventions in patients with urgent surgical diseases in combination with a new coronavirus infection. METHODS AND MATERIALS. We observed for 80 patients with urgent abdominal diseases. Group I – 48 patients with various urgent diseases of the abdominal organs, group II – 32 patients with similar diseases occurring against the background of coronavirus infection. Stages of postoperative examination: 2, 4 and 7 days after surgery. The nature and rate of wound regeneration was assessed by cytological examination of wound exudate. In the tissues along the suture line, trophic indicators and microcirculation were recorded. RESULTS. The number of neutrophilic leukocytes in the wound exudate in group II exceeded the values of group I by 38.7–116.8 % with a slowed down dynamics of recovery. In the II group of patients, the number of tissue polyblasts was reduced at all stages of observation in comparison with the control group by 34.2–41.9 %. The number of lymphoid polyblasts in the main group was increased in comparison with the control group on days 2, 4, 7 of observation by 33.1 %, 63.2 %, 354.9 %, respectively. The indices of microcirculation in the tissues of the laparotomic wound in the group II of patients changed to a greater extent. The redox potential and oxygen diffusion coefficient in the group II were lower than the control figures by 9.8 – 37.2 % and 35.3 – 38.1 %, respectively. The number of complications according to the Clavien – Dindo classification in the group II of patients compared to the group I was more than 6 times higher. CONCLUSION. In patients with urgent diseases of the abdominal organs with concomitant coronavirus infection, the process of incomplete reparative tissue regeneration of the wound area slows down, which increases the risk of complications. The main factors that reduce the rate of tissue healing are disorders of microcirculation and bioenergetics.

Background. In surgical practice, peritonitis remains one of the most serious diseases. The urgency consists of a high prevalence, fatal outcomes, a high probability of progression and development of serious complications. The purpose of the work is to study the state of the hemostasis system in patients with acute progressive peritonitis. Materials and methods. A prospective multicenter cohort study of patients with acute peritonitis was performed. In accordance with the goal, the patients were divided into 2 groups. The first (n=25) group – without complications, the second (n=14) – with the development of complications. Research methods – clinical, biochemical (assessment of liver function and the state of the coagulation system). The study dates are the 1st, 5th, 10th day of the postoperative period. Results. In the early postoperative period, patients with acute peritonitis have significant disorders of the hemostasis system, which are associated with changes in the functional status of the liver. When the phenomena of peritoneal inflammation are relieved, hemostasis indicators are restored. In the group of patients who have postoperative complications, mainly wound ones, the phenomena of hypercoagulemia and inhibition of fibrinolysis progress, which led to the development of deep vein thrombosis of the lower extremities in 3 patients (patients operated). In patients with acute peritonitis with progressive course (tertiary peritonitis, sepsis) there is a transformation of the state of the hemostasis system: hypocoagulation and hypofibrinolysis are recorded against the background of a sharp depression of the functional state of the liver. Conclusions. In patients with acute peritonitis, as the pathology progresses, large liver lesions occur, leading to serious disorders of the coagulation-lytic system and postoperative complications.