Background. An increased intraluminal pressure in the small intestine due to paralytic intestinal obstruction refers to one of the most important factors for development and severity of intra-abdominal hypertension in patients with diffuse peritonitis. Measurement of intraluminal pressure in the small intestine appears technically challenging, therefore, evidence on the effect of intraluminal pressure on the severity of intra-abdominal hypertension is yet to be gathered. Aim. To evaluate the influence of intraluminal pressure on the severity of intra-abdominal hypertension in patients with diffuse secondary peritonitis.Methods. The research was performed according to the design of an observational clinical study on the basis of Regional Clinical Emergency Hospital, Krasnodar Krai, in the period of July 2022‒April 2024. The study considered dynamics of intra-abdominal pressure in 82 patients with diffuse peritonitis. Intraluminal pressure in the small intestine before and after decompression was measured in 34 patients (Group 1) when nasointestinal intubation was performed with the original tube. Group 2 included 48 patients subjected to measuring intra-abdominal pressure without nasointestinal intubation. The measurement of intra-abdominal pressure was performed through urinary catheterization using the Kron technique according to the recommendations of the World Society of the Abdominal Compartment Syndrome (WSACS). The severity of peritonitis was determined using the World Society of Emergency Surgery complication Intra-Abdominal Infections Score (WSES cIAIs Score). Statistical analysis and comparison of ordinal indices in different groups or subgroups were carried out by means of Mann-Whitney U-test; comparison of quantitative indices with normal distribution was performed using Student’s t-test.Results. All patients in Group 1 were detected with a sharp increase in intraluminal pressure in the small intestine, which appeared 50%-responsible for intra-abdominal hypertension. However, no statistically significant dependence between the severity of peritonitis and severity of intra-abdominal hypertension was revealed due to the variety of factors behind peritonitis development and duration of the disease, which determine the severity of paralytic intestinal obstruction. Nasointestinal intubation in Group 1 patients led to a decrease in intraluminal pressure on the average by 59.4% immediately after decompression, which was accompanied by a decrease in intra-abdominal pressure indices by 49.5% from the initial ones. In group 2, intra-abdominal pressure decreased gradually; during the first 5–7 post-operative days its indices in the majority of patients corresponded to the second degree of intra-abdominal hypertension severity.Conclusion. The level of intraluminal pressure in the small intestine determines the level of intra-abdominal hypertension in patients with diffuse secondary peritonitis. Intraluminal pressure depends on the severity of paralytic intestinal obstruction and the pathology behind peritonitis. The level of intraluminal pressure over 30 mm Hg can be considered critical for the development of severe intra-abdominal hypertension and abdominal compression syndrome. In Group 1, nasointestinal decompression of the small intestine enabled intra-abdominal pressure to be rapidly reduced to acceptable level and development of abdominal compression syndrome to be prevented.

Relevance. Due to the pandemic of the new coronavirus infection, changes have occurred in the work of most surgical hospitals aimed at optimizing and improving the provision of medical care. Performing acute and emergency surgical interventions in patients with confirmed COVID-19 infection dictates the need to review surgical tactics. Aim of study. To assess the quality of publications in the scientific press from the standpoint of systematic analysis on the provision of emergency surgical care in remodeled hospitals and to identify the main changes in surgical tactics in patients with abdominal emergency and COVID-19. Material and Methods. The analysis of data from publications dated from December 2019 to July 10, 2021 from electronic databases PubMed, Cochrane Library, Scopus, eLibrary. An analysis of numerous studies, recommendations of national and international surgical, urological, oncological, gynecological, endoscopic and anesthesiological communities and associations, the World Health Organization, temporary guidelines of the Ministry of Health of the Russian Federation on the prevention, diagnosis and treatment of new coronavirus infection was performed. The quality of the selected publications was assessed in accordance with the recommendations. Results. When analyzing the selected publications, it was revealed that most of them are retrospective, uncontrolled one-time studies and descriptions of clinical cases (level 4 evidence, level C recommendation). We found 1 combined (prospective-retrospective) multicenter and 1 retrospective comparative study on the treatment tactics of acute cholecystitis, 1 retrospective multicenter cohort study on acute pancreatitis, 1 retrospective study on acute intestinal obstruction and 2 studies on acute appendicitis, 1 case-control study on gastrointestinal tract and intestinal bleeding (level 3 evidence, level B recommendation). Conclusion. Currently, there are no high-level evidence or recommendations to change surgical tactics in patients with COVID-19 and abdominal emergency.

We performed a comprehensive assessment of the acellular dermal matrix obtained during the detergent-enzymatic treatment of the porcine dermis. Acellular dermal matrix was used for the experimental treatment of a hernial defect in a pig using the sublay method. Sixty days after the surgery, biopsy specimens were obtained from the area of hernia repair. The acellular dermal matrix can be easily modeled depending on the size and shape of the defect during surgical procedures, can eliminate the defect of the anterior abdominal wall, and is resistant to cutting by the suture material. Histological examination demonstrated replacement of the acellular dermal matrix with newly formed connective tissue.

Background. Intra-abdominal hypertension complicates the course of secondary diffuse peritonitis in at least 60–70% of cases. Abdominal decompression is an essential component in the complex of therapeutic measures in patients with secondary diffuse peritonitis. However, no clear criteria for choosing the method and timing of abdominal decompression have been developed so far. The effectiveness of its use in various forms of peritonitis remains controversial. Objectives — to study the dynamics of intra-abdominal pressure in the early postoperative period when using various methods of abdominal decompression in patients with secondary diffuse peritonitis. Methods. The work was performed on the basis of an observational clinical study under the auspices of Regional Clinical Emergency Hospital over a period from January 2021 to December 2022. The authors studied intra-abdominal pressure in 74 patients with secondary diffuse peritonitis in the early postoperative period. In 39 (52.7%) patients (group 1), decompression was carried out in the form of prolonged nasogastric intubation. 15 (20.3%) patients (group 2) underwent nasointestinal intubation. Group 3 was represented by 10 patients (13.5%) which were affected by open abdomen technology and vacuum assisted closure (VAC). Group 4 included patients with vacuum-assisted laparostoma who underwent nasointestinal intubation. The severity of peritonitis was assessed using WSES cIAIs Score and Mannheim Peritonitis Index. The dynamics of intra-abdominal pressure was determined through the urinary catheter using the Uno Meter Abdo Pressure® Kit (Unomedical, Russia) before surgery and within 5 days of the postoperative period. Statistical analysis was based on non-parametric Wilcoxon test for comparing the values of the same group at different periods of observation. Mann-Whitney U-test was used to compare absolute values in different groups. Results. Nasogastric tube did not provide an acceptable reduction in intra-abdominal pressure, especially in patients with severe forms of peritonitis. Prolonged nasointestinal intubation contributed to a steady decrease in intra-abdominal pressure throughout the postoperative period, while simultaneous intubation resulted in an increase in intra-abdominal hypertension after a decline in values one day after surgery. The best results of intra-abdominal pressure dynamics were observed in case of vacuum-assisted laparostomy and its combination with nasointestinal intubation. Throughout the postoperative period, the intra-abdominal pressure did not exceed 15–17 mmHg. This method can be used only in treatment of the most severe forms of peritonitis, with indications for sanitation relaparotomy and in case of threatened abdominal compression syndrome. Conclusion. The data obtained enable the process of choosing surgical tactics and method of abdominal decompression to be optimized with respect to the severity of peritonitis and intra-abdominal hypertension.

Tumors of the small intestine account for up to 5 % of tumors of the gastrointestinal tract; preoperative diagnosis of complicated tumors of the small intestine is one of the most difficult problems in surgery. Based on a retrospective study of the results of examination and treatment of 101 patients, an analysis of the clinical and pathomorphological manifestations of complicated tumors of the small intestine was carried out, a list of necessary diagnostic measures was determined with an assessment of their diagnostic capabilities, which allowed to increase the effectiveness of surgical treatment.

OBJECTIVE:To estimate the efficiency of stimulation of reparative processes in patients with diabetes mellitus type 2 and trophic ulcers of the lower limbs.MATERIAL AND METHODS:There were 94 patients with diabetes mellitus type 2 complicated by trophic ulcers of the lower limbs. Mean age of patients was 67.8±8.6 years. The main group consisted of 50 (53.2%) patients who underwent stimulation of reparative processes, control group - 44 (46.8%) patients with standard treatment and hydrocolloid dressings. Efficiency of treatment was analyzed every 5 days considering wound healing and cytological data.RESULTS:We found significant reduction of neurotrophic ulcer volume by 29.9% after 10 days. Positive macroscopic data were accompanied by reduction of white blood cells count up to 40-50% and increase in the number of histiocytes and endothelial cells. Among patients with ischemic ulcers, we obtained significant reduction of ulcerative defect only after 15-20 days in 3 (60%) cases. Overall efficiency of original management way 96%, mean duration of treatment - 37.1±5.9 days. In the control group, overall efficiency of treatment was 70.5%, duration of treatment - 45.9±6.1 days.CONCLUSION:The original method was valuable to improve the outcomes in patients with diabetes mellitus type 2 and trophic ulcers of the lower limbs. The best results were obtained for neurotrophic ulcers. In case of ischemic ulcers, these technologies should be combined with measures on improvement of pulsatile blood flow and microcirculation. This method does not require hospitalization and reduces treatment cost.

Objective: To determine the optimal technological modes for the preparation of platelet-rich plasma (PRP) using standard laboratory equipment.Material and methods: Blood for the research was taken from 25 healthy volunteers. Its centrifugation was performed on a standard CM-6M laboratory centrifuge using various modes and two types of vacuum tubes with lithium heparin containing separation gel and without it. The number of platelets and leukocytes was calculated in the upper, lower and middle layers of the obtained plasma sample.Results: Plasma samples obtained during centrifugation modes from 415 to 1660 g for 10 minutes using test tubes that do not contain separation gel are optimal in terms of the number of platelets. Plasma intake from the lower layer of the obtained sample after centrifugation is always accompanied by the inclusion of leukocytes in its composition, which can lead to undesirable tissue reactions when it is used.Conclusion: To obtain PRP, it is possible to use standard laboratory equipment in the centrifugation mode from 415 to 1660 g for 10 minutes using test tubes that do not contain separation gel. Plasma sampling for clinical use should be carried out from the middle layer of the obtained sample.

Objective: To study the evolution of approaches to surgical treatment in patients with open abdominal trauma.Material and methods: The results of surgical treatment of 141 patients with open abdominal trauma at the age of 32.6 ± 7.3 years have been studied. In the main group of 73 patients, surgical tactics have been determined according to the results of the Focused Assessment with Sonography for Trauma (FAST) protocol and diagnostic video laparoscopy. In the control group of 68 patients, indications for laparotomy have been presented based on the proven fact of a penetrating wound in the abdominal cavity.Results: In patients with unstable hemodynamics and signs of peritonitis there is no need for additional verification of the damage nature. In these cases, an emergency laparotomy is justified. In debatable cases diagnostic video laparoscopy should be the method of choice for the diagnosis. In 19 (27.9%) patients in the control group with the proven fact of a an abdominal penetrating wound during primary surgical treatment (PST), no injuries were detected during the examination of the abdominal organs and the laparotomy was exploratory.Conclusion: A rational approach to assessment of the injuries severity using the FAST protocol and diagnostic video laparoscopy in patients of the main group made it possible to completely avoid exploratory laparotomy and increase the proportion of minimally invasive interventions to 50–70%. The accuracy of laparoscopic diagnostics was 98%.

We planned to develop a tension-free hernioplasty method for giant and large postoperative ventral hernias. Twenty-three patients with complicated postoperative ventral hernias were operated on using the method. Ultrasound, computed tomography, and plain radiography of the abdominal organs were performed for diagnosis.We have developed a tension-free hernioplasty method, where we placed a mesh implant between the fl aps of the hernial sac in order to isolate it from the abdominal organs and subcutaneous fat. When applying this method, positive results were obtained (this method is absolutely tension-free plasty of the anterior abdominal wall, since own tissues are not put together; the location of the mesh implant made it possible to signifi cantly reduce or almost completely avoid local complications, such as seroma, suppuration of the postoperative wound, fi stula formation.This method can signifi cantly reduce the percentage of local complications and completely avoid compartment syndrome in the early postoperative period. In all patients operated on by the method, no relapses were observed during the follow-up period (3 years).

Background. With the introduction of synthetic mesh implants into clinical practice, the recurrence rate of postoperative ventral hernias was signifi cantly reduced. The extensive use of synthetic implants led to the development of specifi c complications. The development of biological implants, based on extensively purifi ed decellularized collagen matrix of xenogeneic origin is highly relevant due to the fact that, unlike synthetic analogues, they have a biological origin and biodegrade in a natural way, gradually being replaced with newly formed connective tissue. The use of bioprostheses reduces the risk of complications.Objectives. To conduct a comparative evaluation of the biomechanical characteristics of acellular dermal matrix, obtained by detergent-enzymatic decellularization, and commercially distributed Permacol™ matrix.Methods. Acellular dermal matrix (ADM) was created by using samples of native skin of pig of Landras breed aged 4 months. The dermis was processed by means of detergent-enzymatic method. In order to evaluate and compare the mechanical properties of acellular dermal matrix, the biological samples were divided into 2 groups of 15 samples each. The fi rst group included acellular dermal matrix samples, the second group — native samples of pigs unprocessed dermis. The control group consisted of samples of PermacolTM Surgical Implant, xenotransplant for hernioplasty approved for use in the Russian Federation (Covidien, France). All samples were tested wet using universal testing instrument Instron 1122. MedCalc Statistical Software (Belgium) was used for statistical processing of the study results.Results. In the present study, pig dermis was processed using a detergent-enzymatic method to produce ADM. Routine histological examination confi rmed the removal of all cellular elements, and at the same time it was proven that the native structure of the dermis remained intact during its processing. The mechanical characteristics of xenogenic ADM were further determined. Its tensile strength was 9.1 ± 0.6 MPa (910 N/cm2 ), elongation to break was 21.1 ± 2.3%, and elastic modulus was 50.0 ± 1.6 MPa. These characteristics largely corresponded to the strength characteristics of native pig dermis and far exceeded the necessary physiological parameters. PermacolTM control was tested in two directions (longitudinal and transverse). In the longitudinal direction, the sample had higher mechanical characteristics: strength — 12.0 ± 1.7 MPa, elongation to break — 29.7 ± 2.4%, stiffness modulus — 47.2 ± 6.5 MPa. In the transverse direction, all indicators were 1.5–2 times lower.Conclusion. The developed xenogeneic biological implant in the form of ADM demonstrates rather good characteristics of plasticity, tensile strength and elasticity, to be used as a biological endoprosthesis for plasty of hernia defects of the abdominal wall of any size and shape.

ХАРАКТЕРИСТИКА КАЧЕСТВЕННОГО СОСТАВА ВОЗБУДИТЕЛЕЙ И ЭМПИРИЧЕСКАЯ АНТИБАКТЕРИАЛЬНАЯ ТЕРАПИЯ У БОЛЬНЫХ С ПОДВЗДОШНО-ТАЗОВЫМИ ФЛЕГМОНАМИ

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.Material and Methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.Results and Discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

Aim. Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment. Material and methods. This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data. Results and discussion. Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%. Conclusion. The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

Aim. To analyse the dynamics of morbidity and mortality from diseases of the digestive system, as well as the quality of medical care for gastroenterological patients in the Krasnodar Krai.Materials and methods. The analysis was carried out according to C 51 “Distribution of deaths by gender, age groups and causes of death” form of the Territorial Authority of the Federal State Statistics Service for the Krasnodar Krai for the period from 2006 to 2018, as well as on the basis of the “Demography” block database of the Parus software of the healthcare management system of the Krasnodar Krai for 6 months of 2019. 1341 medical records of patients receiving outpatient medical care and the medical records of people who had died from digestive diseases in 2017-2019 were reviewed.Results. Digestive diseases (DD) occupy the fourth place (7.1 %) in the structure of the general morbidity of the population in the Krasnodar Krai. Over the study period (13 years), the structure of mortality from DD has not changed significantly among the region’s population. About 70% of the causes of death from DD among people of working age account for liver diseases. The pathology of the pancreas takes the second place (13.5 %). The peptic ulcer of the stomach, duodenum and “other diseases of the digestive system” (8.8 % and 7.7 %, respectively) are represented in almost equal shares. In the etiological structure of liver cirrhosis, viral (39 %) and alcoholic (36 %) liver diseases are leading. The frequency of viral liver lesions tends to decrease, while the proportion of liver cirrhosis in the outcome of non-alcoholic fatty liver disease (NAFLD) progressively increase, having reached 7 % in 2017–2018. In the group of patients with inflammatory diseases of the pancreas, men prevail (66.9 %), often those abusing alcohol. The third leading cause of mortality from DD in the Krasnodar Territory is pathological conditions that occurred in the upper gastrointestinal tract (acute stomach ulcer, duodenal ulcer with bleeding, perforation) in older age groups taking antiplatelet agents and non-steroidal anti-inflammatory drugs (71.8 %). Conclusions. The main causes of death among the population of the Krasnodar Krai from diseases of the digestive system at a young age are alcohol consumption with unhealthy consequences. At the same time, people of older age groups die from a lack of prevention of ulceration and inadequate eradication of Helicobacter pylori in patients taking non-steroidal anti-inflammatory drugs and antiplatelet agents.

The comparative analysis of results of elimination of perforative ulcers by a method radical duodenoplastic or sewed perforative apertures is lead. The technology radical duodenoplastic in connection with character of patomorfological changes of gastro-duodeno-pancreatical complex, presence of accompanying complications is individualized. Plans of postoperative rehabilitation are resulted.

Opportunities of rendering of medical aid by the patient with the complicated stomach ulcer of a duodenal gut at a municipal level in a primary part of public health services are investigated. Clinical advantages of operative treatment to a method radical duodenal plastics are proved. Opportunities of the economic analysis are expanded due to estimation of cost and efficiency of algorithms of conducting patients. For the characteristic of patients life quality are applied objective and value judgment, it is international comparative criterion. The years of a qualitative life got as a result of medical interventions quality adjusted life-year index QALY which enables to receive an integrated estimation of quality of spent treatment.