Introduction. The article describes the first experience of concomitantly using regional endovascular drug administration and vacuum-assisted laparotomy in the combination therapy of widespread purulent peritonitis. Materials and methods. In 2023 (from January to November 2023), 25 patients with widespread purulent peritonitis were treated at Surgery Unit No. 2 (Septic Surgery Unit) of the G.G. Kuvatov Republican Clinical Hospital. Results. The proposed treatment method was applied in three patients. The case fatality rate in the comparator group ( n = 22) was 40.9 %. No fatalities were reported among patients who underwent the proposed procedure ( n = 3). Discussion. The clinical picture and dynamics of changes in proinflammatory markers (procalcitonin, blood leukocytes, and C-reactive protein) in the context of endovascular therapy indicate peritoneal inflammation relief and a possible correlation between these events. Conclusion. We believe that the proposed treatment regimen has a positive effect in the treatment of widespread abdominal inflammatory processes and requires further study.

Introduction. Traumatic liver injury is associated with the danger of developing various insidious complications, with some of them appearing immediately and others — eventually against a background of apparent clinical recovery. Modern sophisticated methods enable the character and localization of liver complications to be accurately revealed and those complications to be stopped by means of minimally invasive techniques. Materials and methods. A clinical case of the traumatic hepatic rupture caused by a fall from height and the subsequent development of successive complications, which, except for the primary surgery — suturing of the liver rupture through laparotomy — were stopped by minimally invasive techniques. Results and discussion. All complications that occurred and were subsequently treated have been divided into seven stages. Stage 1: rapid transfer of the patient to a multidisciplinary hospital. Stage 2: diagnostic laparoscopy followed by laparotomy and suturing of the liver rupture. Stage 3: puncture of the infected biloma. Stage 4: minilaparotomy cholecystectomy. Stage 5: antegrade percutaneous transhepatic drainage of the bile ducts. Stage 6: angiography of the hepatic artery and its branches. Stage 7: endovascular embolization of the pseudoaneurysm cavity. Conclusion. The authors presented the clinical case in order to demonstrate the feasibility and proper application of minimally invasive techniques to manage various complications of liver injury, avoid resection, save life, and preserve quality of life.

Relevance. To evaluate the effectiveness of X-ray endovascular embolization of the portal vein branch in terms of preparation for extensive liver resections. Materials and methods. A retrospective analysis of 74 right-sided hemihepatectomies performed in one stage (classical, n = 54) or in two stages (X-ray endovascular embolization of the right portal vein followed by liver resection was performed, n = 20).Results. X-ray endovascular embolization of the right portal vein was accompanied by a significant increase in the planned liver remainder by an average of 37.3 %. This made it possible to reduce the volume of intraoperative blood loss, the incidence of postresection hepatic failure from 43.1 to 15.9 %, and postoperative mortality from 9.3 to 5.0 %.Conclusions. Preoperative X-ray endovascular embolization of the right portal vein leads to vicarious enlargement of the left lobe of the liver. This makes it possible to reliably reduce the incidence of post-resection hepatic failure after right-sided hemihepatectomy and, accordingly, reduce the frequency of deaths.

Background. The new SARS-CoV-2 coronavirus infection is understudied; despite its worldwide prevalence, case reports of organ transplant recipients are rare.Aim. A dynamics evaluation and treatment outcome improvement in a transplanted cadaveric kidney patient with 100% parenchymal lung damage caused by SARS-CoV-2 coronavirus bilateral pneumonia.Materials and methods. We describe a successful treatment case of a transplant kidney patient having the new coronavirus infection (COVID-19) (of 03.12.2020). COVID-19 pneumonia was diagnosed on day 7 of the early post-transplant period. On day 14, the patient was admitted to an infectious ward and transferred to intensive care upon disease aggravation. Despite ongoing treatment, pulmonary parenchymal lesion reached 100% in CT scan on 24.12.2020. The patient was transferred to Surgery Unit No. 3 for further therapy on 11.01.2021 upon revealing a clinical improvement, positive laboratory dynamics and SARS-CoV-2-negative smear PCR tests. The patient was discharged for outpatient treatment on day 10.Results and discussion. No evidence of focal infiltrative pulmonary change was detected in control chest CT after 4 months. Within 5 months since discharge, there were observed a general well-being improvement, 98% oxygen saturation, absent oedema, satisfactory transplanted kidney function.Conclusion. Post-kidney-transplant patients are particularly susceptible to infection due to inherent chronic immunosuppression. The presented case of a kidney transplant patient having a favourable COVID-19 outcome demonstrates the efficacy of a timely treatment.

Introduction. Liver transplantation is currently considered to be the only method of radical treatment for adults and children with incurable liver diseases. The most important aspects of liver transplantation are the correct selection of an appropriate recipient and compilation and maintenance of a liver transplant waiting list. This article aims to analyze the structure of the severe chronic liver disease patient population included in the liver transplant waiting list at the G. G. Kuvatov Republican Clinical Hospital (the City of Ufa).Materials and methods. We analyzed the waiting list drawn and maintained over the 2007-2018 period based on the examination of 789 patients with liver cirrhosis of various etiologies.Results and discussion. Out of all the patients with liver cirrhosis of different etiologies (Child-Pugh score classes A, B, and C) 149 (18.8 %) were included in the waiting list. The ages of patients included in the liver transplant waiting list ranged from 19 to 69. The mortality rate amounted to 38.9 % (58 people); of these patients 31 (53.4 %) had hepatic cirrhosis (HC) of autoimmune etiology, 18 (31.0 %) — HC of viral etiology, and 6 (10.3 %) — alveococcosis of the liver. The rate of the waiting list expansion for patients aged 20-29 compared to those aged 0-19 amounted to 1.32 %. Such a dynamics for the 30-39 age group compared to the 20-29 age group was 11.51 %. The number of people aged 40-49 compared to the preceding age group remained the same.Conclusion. Our analysis of the waiting list sets the percentage of patients with autoimmune HC in the population of patients with this disease at 59 %. These patients are characterized by a rapid progression of liver failure and high mortality. The statistical analysis of liver transplant waiting lists facilitate the optimization of procedures used to select and manage such patients, as well as to prevent, in a timely manner, the development of complications thus improving the prognosis of survival.

Introduction. Refeeding syndrome is a condition underpinned by metabolic disorders emerging as a result of the resumption of feeding in patients after a protracted period of starvation. The real figures of the potentially life threatening refeeding syndrome incidence are unknown. This paper aims to demonstrate the clinical picture and methods of resolving of the refeeding syndrome by presenting a clinical case.Materials and methods. The clinical presentation of the refeeding syndrome with pronounced neurological and cardiological symptoms is demonstrated on the example of a female patient with acute pancreatitis of medium severity at the resumption of enteral feeding. A review of available literature on the subject is also presented.Results and discussion. The range of diagnostic considerations was rather broad as the authors had to eliminate acute coronary and neurological disorders. The auxiliary laboratory examination methods helped form the hypothesis of a developing refeeding syndrome and correct the treatment. Parenteral phosphate-containing preparations and enteral feeding with phosphates were administered. The patient was transferred to the neurology department for further treatment. The patient was discharged home on day 53 with total regression of neurological symptoms.Conclusion. Hypophosphataemia — a very low level of phosphorus in blood — is a key clinical marker of the syndrome. However, low blood levels of potassium, calcium, magnesium and vitamin В1 may also play a role. Chronically undernourished patients and those not having any enteral feed for over 10 days are fall in the high risk group. The feeding should be resumed at a low level energy intake. Vitamins should be prescribed at the resumption and continued for at least 10 days. The electrolyte and fluid balance does not have to be corrected prior to the resumption of feeding; it can be done simultaneously with feeding.

Introduction. One of the worst complication of different surgical diseases of abdominal cavity organs and of performed, on that regard, operational interventions, are intestinal festulas including without limitation deodenum fistulas. Longterm experience of surgical treatment of patients with unformed duodenal and high enteric fistulas show that it is feasible to have a clear surgical tactics with account of location level and type of fistulas, their quantity, volume of sarcous reduction, peritonitis and multi-organ failure syndrome. In this regard, the objective of this research is to find optimal surgical tactics and to determine the most effective method of treating duodenum fistulas of various causation.Materials and methods. Experimental work was carried out under conditions of experimentally formed intestinal fistula in rabbits of “Shinshilla” breed. After formation of fistula the animals were divided into 3 groups based on the method of removing artificially installed duodenal fistula: sealing through Albert — Schmieden — Lembert suture without fastening of suture line; sealing through fastening of intestinal suture with biological surgical glue; sealing through fastening with swine dermal collagen. Mechanical constancy of the sutures was measured with pneumocompression of sealed intestinal tract areas as well as with morphological study of surgical wound edges.Results. The results of histological study show that experiments with application of bio-implant demonstrated less vascular congestion and interstitial swelling. Phologistic infiltration also responded more efficiently both quantitatively (manifestation rate) and qualitatively (quick change of cell elements) in the group that used bio-implant.Conclusion. Results of morphological studies and pneumocompression data under modelling of duodenal fistulas in experimental animals show that application of bio-implant helps to earlier restore microcirculatory abnormality.

This article presents the concept of GIST-tumors, their prevalence, location in the overall cancer incidence. Aspects of the morphological features and clinical cases of tumors GIST are described. The survey methodology, describes methods of surgical treatment and results are recommended.

According to official statistics, in the Republic of Bashkortostan (RB) since 1991 there is noted the increase in the number of patients with cystic echinococcosis. In 2012, the number of recorded cases increased by 55.3% if compared with 2007. In the areas of RB, where there was observed the high index of population morbidity rate, there was noted the extensive growth of the infestation in sheep. The analysis of the landscape-climatic and sanitary characteristics of the territory of the RB, as well as population economic activity revealed a definite relationship between them and the spread of echinococcosis. The performed survey of rural residents of RB showed that the population is poorly informed about the factors of transmission and ways of infection by echinococcosis. Out of respondents 73% were wrong in determining factors of transmission of infection, 34% admitted irregularities in the disposal of slaughtering condemned products. Fully correct answers were given only by 9% of respondents. The research of fruitfulness of hydatid bubbles and viability of Protoscolexes revealed that the effect of hot water (t = 90-100 ° C) is effective for disinfecting of invasive origins of larvocysts. Due to the low level of awareness of the population there is needed an active health education work on effective measures to prevent the spread of echinococcosis in RB--the prevention of feeding dogs with raw slaughtering waste and decontamination in the private courtyard slaughtering condemned products with the hot water.

The article presents a newly developed method for creation of a temporary external shunt using a T-shaped tube drainage for intestinal diversion of bile in patients with iatrogenic injuries of external biliary ducts against the background of obstructive jaundice, cholangitis and biliary peritonitis. A temporary shunt allows to avoid the daily oral intake of the patients own bile, and to prepare the stump of hepaticoholedochus to the formation of a broad hepaticojejunostomy on the second stage of surgical treatment without frame transpency drains.

Presented the experience of four successful liver transplants in Bashkiria shows the possibility of full social and medical rehabilitation and save the lives of patients with terminal liver disease. Undoubtedly, these operations should be performed in specialized centers with expertise in liver surgery, vascular surgery, renal transplantation and management of patients after organ transplantation. According to the complexity, technical complexity, and trauma surgery for liver transplantation is justly considered the most complex surgery on abdominal organs and require special conditions. The clinics must be qualified transplant and resuscitation-anesthesia care team of doctors, modern diagnostic and surgical equipment and advanced laboratory services.

Liver abscesses of various origins are a group of severe purulent diseases of the liver and are considered to be one of the difficult problems of the hepatobiliary system. Their frequency in the general structure of surgical diseases ranging from 0,006 to 0,5% has no tendency to decrease due to the significant increase in the number of inflammatory diseases of the gallbladder and biliary tract, as well as the increased number of surgical interventions on the bile ducts and liver leaving stents and transhepatic drainage. The article provides an overview of current literature data on the diagnosis and treatment of liver abscesses.