RATIONALE Hollow organ perforation is an urgent problem in abdominal surgery. According to the literature, the incidence of perforation is from 0.37% to 2.3% of cases among various acute surgical pathologies of the abdominal organs. The greatest attention in the literature is paid to the problem of perforated gastroduodenal ulcers. At the same time, a much smaller number of publications, both Russia and foreign, are devoted to other, more rare types of perforations. This situation is most likely explained by the low prevalence of other types of perforations, which, in turn, does not make them a less urgent problem in emergency surgery, which requires a modern approach to the treatment of this group of patients.PURPOSE OF THE STUDY Analysis of domestic and foreign literature on the diagnosis and treatment of rare types of benign intestinal perforations.MATERIAL AND METHODS A literature review was performed for the period from 1994 to 2020 in Russian and in English, available on Pubmed, Medline, Springer, Scopus, E-library, on topics such as perforated diverticula of the small intestine, perforation of Meckel’s diverticulum, perforated ulcers of the small intestine, perforation of the intestine by a foreign body. RESUltS With all the variety of surgical techniques for various types of perforation of the gastrointestinal tract, currently in the literature there are no specific criteria for choosing a particular method of intervention with regard to the cause, level, and duration of perforation.CONCLUSION The lack of unified approaches in the diagnosis and treatment of patients with rare GIT perforations dictates the need for a more in-depth study of this issue in order to apply and optimize the technique of videolaparoscopic approach, develop a treatment and diagnostic algorithm for patients with suspected perforations of the gastrointestinal tract using the video laparoscopic method.

The article presents the results of video laparoscopy (VLS) performed in 2008–2019 in 5,599 patients in order to diagnose acute diseases of the abdominal organs requiring emergency surgery, identify competing and concomitant diseases, and determine treatment tactics. 2,442 (43.6 %) of them made up group I, with no doubt; 2,656 (47.4 %) – II group, with presumptive reliability; and 501 (9.0 %) – group III, with an unclear clinical diagnosis of the disease. In 2,326 (95.2 %) patients of group I with VLS, the clinical diagnosis was confirmed, in 100 (4.1 %) other diseases were revealed, and in 16 (0.7 %) the diagnosis was not established. Competing diseases were found in 8 patients and concomitant diseases in 4. In 1,641 (61.8 %) patients of group II, VLS made it possible to clarify and differentiate the clinical diagnosis of diseases, in 929 (35.0 %) – to identify other diseases, and in 86 (3.2 %) the diagnosis was not possible. When performing differential diagnosis, 126 other diseases were identified more than the number of patients. Competing diseases were found in 6 patients and concomitant diseases in 6 patients. 356 (71.0 %) patients of group III with VLS were diagnosed with major diseases, 75 (15.0 %) had other diseases, and 70 (14.0 %) were not diagnosed. In 4 patients, competing diseases were found, and in 1 – concomitant disease. Of the 5,427 (96.9 %) patients with the definitive diagnosis of the disease established with VLS, 3,828 (70.5 %) were found to be able to perform VLS operations, in 10 (0.3 %) of them – simultaneous with competing diseases.

Objective To analyze the capabilities of laparoscopy in the diagnosis and treatment of atypical diseases. Material and methods Laparoscopy was performed in 5188 patients with established, suspected and unclear diagnosis of acute surgical diseases for the period from 2008 to 2018. Rare atypical diseases were diagnosed in 114 (2.2%) patients. These diseases simulated established and suspected clinical diagnoses in 100 (87.7%) cases, and the diagnosis was unclear in 5 (4.4%) cases. In 9 (7.9%) patients, atypical diseases were concomitant. In 7 cases, atypical diseases competed with the underlying disease and required emergency surgery. Conservative treatment was required in 2 cases. Seventy (61.4%) patients with atypical diseases needed emergency surgery, and 44 (38.6%) patients required conservative treatment. Laparoscopic operations were performed in 61 (87.1%) patients including simultaneous procedures in 8 cases and video-assisted interventions in 2 (2.9%) patients. Laparotomy was applied in 7 (10.0%) patients. Results Histological examination confirmed laparoscopic diagnosis in 66 out of 68 specimens. Cells of mucus-forming adenocarcinoma were detected in one resected epiploic appendix, carcinomatosis - in one segment of resected omentum. Conclusion Video-assisted laparoscopy was valuable to establish a diagnosis and determine surgical strategy, detect competing and concomitant diseases, perform operations including simultaneous procedures.

Objective -to evaluate the possibilities of laparoscopy in the diagnosis and treatment of acute abdominal surgical diseases. MATERIAL AND METHODS A retrospective analysis of laparoscopic procedures in 4655 patients with confirmed or suspected acute abdominal surgical diseases for the period 2008-2017 was performed. Laparoscopy was applied to confirm or to determine unclear diagnosis. RESULTS Diagnosis was established and confirmed in 4526 (97.2%) patients. Advisability of laparoscopic surgery was confirmed in 3091 (68.3%) patients, laparotomy - in 491 (10.8%) patients. Surgical treatment was not required in 944 (20.9%) patients. Laparoscopic procedures were performed in 3050 (98.7%) patients, 41 (1.3%) patients required conversion to laparotomy. Laparoscopic approach failed to define diagnosis in 129 (2.8%) patients that required conversion to diagnostic laparotomy. CONCLUSION Laparoscopic was valuable to establish the diagnosis and determine surgical strategy, diagnose concomitant diseases, perform operations including simultaneous ones.

AIMTo assess laparoscopy in diagnosis and treatment of patients with perforated gastroduodenal ulcers.MATERIAL AND METHODSThere were 273 patients with perforated gastroduodenal ulcers who underwent laparoscopy at the Sklifosovsky Research Institute for Emergency Care in 2010-2016. Sample included patients with clinical and instrumental diagnosis of perforated gastroduodenal ulcers, suspected hollow organ perforation including perforated ulcer and other acute abdominal diseases followed by perforated ulcer.RESULTSLaparoscopy confirmed diagnosis of perforated gastroduodenal ulcer in 82.5% of patients with clear preoperative diagnosis and in 54.2% of patients with suspected perforated ulcer. Video-assisted closure of the ulcer is possible in 81.7% of patients. Any endoscopic procedure should be started from diagnostic measures. Diagnostic laparoscopy followed by curative laparotomy in 14.6% of patients was able to clarify diagnosis, suture technically difficult perforated ulcer and prevent possible complications.

AIM:To analyze videolaparoscopic diagnosis and treatment of abdominal pathology simulating acute appendicitis (AA).MATERIAL AND METHODS:For the period 2008-2015 at Sklifosovsky Research Institute of Emergency Care 2784 patients with suspected AA underwent clinical, laboratory and ultrasonic examination. Depending on survey results patients were divided into 2 groups. Group I included 1352 (48.6%) patients with AA, group II - 1432 (51.4%) patients with suspected AA. All of them underwent videolaparoscopy.RESULTS AND DISCUSSION:Videolaparoscopy confirmed AA in 1308 (96.7%) patients of group I and 856 (59,8%) patients of group II. In the 1st group 36 (2.7%) patients had pathology simulating AA and 8 (0.6%) patients had not organic changes; in the 2nd group these values were 462 (32.3%) and 114 (7.9%) respectively. Absence of organic changes was explained by functional bowel disorders. In 95 (3.4%) out of 498 (17.9%) patients of both groups with simulating diseases videolaparoscopy was made and in 49 (1.8%) cases indications for laparotomy were established. In 354 (12.7%) patients with simulating diseases and 122 (4.4%) patients without organic changes operations were not carried out.CONCLUSION:Videolaparoscopy in patients scheduled for appendectomy or with unclear clinical picture allows to diagnose various forms of AA, simulating diseases and to perform necessary surgery.

Today, in connection with the development of surgical techniques, one of the main tasks is minimization of surgical trauma, reduction of postoperative complications and mortality, as well as the timing of hospital treatment of patients with maintained quality of surgical care. The widespread adoption of endoscopic surgery techniques into daily practice may help achieve the goal. Annually, we perform more than 450 laparoscopic surgeries for acute surgical diseases at the Institute, and we have performed more than 6,000 interventions since 2000. however, the laparoscopic method of surgery is not a priority, there are strict indications and contraindications, which we followed and thus avoided the development of iatrogenic complications associated with the use of this method for urgent diseases. Today, the laparoscopic technique is used in acute appendicitis, perforated gastric ulcer and duodenal ulcer, acute cholecystitis, strangulated hernia of the anterior abdominal wall, intestinal obstruction, as well as in patients with abdominal trauma. The use of the laparoscopic method in emergency abdominal surgery improves the quality of diagnosis and treatment, reduces the number of postoperative complications and mortality, as well as the time of treatment.

Today, in connection with the development of surgical techniques, one of the main tasks is minimization of surgical trauma, reduction of postoperative complications and mortality, as well as the timing of hospital treatment of patients with maintained quality of surgical care. The widespread adoption of endoscopic surgery techniques into daily practice may help achieve the goal.Annually, we perform more than 450 laparoscopic surgeries for acute surgical diseases at the Institute, and we have performed more than 6,000 interventions since 2000. however, the laparoscopic method of surgery is not a priority, there are strict indications and contraindications, which we followed and thus avoided the development of iatrogenic complications associated with the use of this method for urgent diseases. Today, the laparoscopic technique is used in acute appendicitis, perforated gastric ulcer and duodenal ulcer, acute cholecystitis, strangulated hernia of the anterior abdominal wall, intestinal obstruction, as well as in patients with abdominal trauma. The use of the laparoscopic method in emergency abdominal surgery improves the quality of diagnosis and treatment, reduces the number of postoperative complications and mortality, as well as the time of treatment.

AIM:To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014.MATERIAL AND METHODS:Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively.RESULTS:Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

Introduction: Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury. The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. Patients and Methods: The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and “traditional” splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Results: Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after “traditional” splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than “traditional” splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Conclusions: Laparoscopic splenectomy is a safe feasible operation in patients with spleen injury. The operation is indicated in patients with spleen laceration >3 cm of parenchymal depth with moderate continuing bleeding or expanding hematoma and contraindicated in patients with hemodynamic instability and high bleeding rate (>500 mL/h on serial ultrasound examinations).

The treatment results of 769 patients with acute calculous cholecystitis and high operational and anesthetic risk at admission are presented in the retrospective study. High risk was determined by expressed comorbidities, diseases' terms, the complications of acute cholecystitis, age, which was more than 60 years in most cases. The patients were divided into 2 groups depending on the severity of comorbidity and the possible effects of its correction. The first group included 617 perspective patients for cholecystectomy. And the second group included 152 patients unpromising for this. Concept of stage treatment was used in the first group including primary decompression of the gallbladder by using of percutaneous transhepatic micro-cholecystostomy under ultrasound guidance. Cholecystectomy was performed after correction of comorbidities, complications of acute cholecystitis, and readjustment of extrahepatic bile ducts by endoscopy if necessary. Laparoscopic cholecystectomy was successfully performed in 587 patients. There was open cholecystectomy in 11 cases. Cholecystectomy was done in 19 patients as a result of conversion. Cholecystostomy from minimal access with extraction of stones under local anesthesia was performed in the second group for decompression and as definitive treatment. There was not observed deaths in patients with high operational and anesthetic risk as a result of such tactics. Postoperatively 1.7% of patients had complications that were successfully resolved.

The authors show the role of hepatobiliscintigraphy (HBSG) in cholelithiasis as a screening technique in evaluating the patency of the common bile duct, which allows cholecystectomy to be performed if there are normal values, without resorting to additional studies. They have reprospectively analyzed the results of clinical and instrumental studies in 101 patients with cholelithiasis and obstructive jaundice of various etiology in whom the diagnosis was verified by endoscopic cholangiopancreatography (ERCPG). The sensitivity, specificity, and diagnostic efficiency of the scintigraphic technique were 96.5, 36.3, and 86.1%, respectively. It is recommended that invasive diagnostic techniques, such as ERCPG and other direst X-ray contrasting methods, should be used after having a positive result of two techniques: ultrasonography and HBSG (in the above order).

Changes in the levels of plasma proteins albumin, transtiretine, transferrin, C-reactive protein, orosomucoid, and alpha 1-antitrypsin were followed up in patients with acute cholecystitis. Acute-phase response develops in acute cholecystitis; its development is most accurately characterized by the concentrations of C-reactive protein. The content of this protein together with the concentrations of transtiretine, orosomucoid, and alpha 1-antitrypsin can be regarded as an indicator of the severity of inflammation of the gallbladder and helps predict the disease course and define the terms of an intervention by the least invasive methods of treatment.

The role of hepato-bilio scintigraphy in examination of 47 patients with acute cholecystitis was evaluated. Laparoscopic cholecystectomy was performed in all the patients. The existence of a functionally "dead" gallbladder in most cases presupposes the existence of marked inflammatory and infiltrative alterations of the neck of the gallbladder, a chronic decline of liver function in patients with calculous cholecystitis complicated with mechanical jaundice and pancreatitis. The effectiveness of hepato-bilio scintigraphy in detection of extra liver biliary tracts obstruction is proved. Hepato-bilio scintigraphy is a highly informative method of diagnosis in acute cholecystitis that makes it possible to evaluate functional status of the liver, gallbladder, cystic duct, extra liver biliary tracts.