Optimal treatment for adhesive small bowel obstruction (SBO) is not defined. Surgery is the only method of treatment for obvious strangulating SBO. Non-operative management (NOM) is widely used among patients with low risk of strangulation, i.e. no clinical, laboratory and CT signs. Randomized controlled trials (RCTs) are recommended to determine the optimal method (early intervention or NOM), but their safety is unclear due to possible delay in surgery for patients needing early intervention. MATERIAL AND METHODS:A RCT is devoted to outcomes of early operative treatment and NOM for adhesive SBO. The estimated trial capacity is 200 patients. Thirty-two patients were included in interim analysis. In 12 hours after admission, patients without apparent signs of strangulation were randomized into two clinical groups after conservative treatment. Group I included 12 patients who underwent immediate surgery, group II - 20 patients after 48-hour NOM. The primary endpoint was success of non-surgical regression of SBO and reduction in mortality. To evaluate patient safety, we analyzed mortality, complication rates and bowel resection in this RCT with previously published studies. RESULTS:In group I, all 12 (100%) patients underwent surgery. Only 4 (20%) patients required surgery in group II. Mortality, complication rates and bowel resection rates were similar in both groups. Strangulating SBO was found in 8 (25%) patients. Overall mortality was 6.3%, bowel resection rate - 6.3%, iatrogenic perforation occurred in 3 (18.8%) patients. These values did not exceed previous findings. CONCLUSION:Non-operative management within 48 hours prevented surgery in 80% of patients with SBO. Interim analysis found no significant between-group differences in mortality, complication rates and bowel resection rate. Patients had not been exposed to greater danger than other patients with adhesive SBO. The study is ongoing.

Primary hyperthyroidism is a common endocrine pathology, with parathyroid adenoma being the most frequent cause of this condition. A number of patients have deep-seated mediastinal adenomas which poses certain challenges in diagnostics and impose serious limitations for performing a surgery using a traditional transcervical approach. Nonetheless, the combination of modern tools of topical diagnostic investigations along with mini-invasive surgical methods allow to perform a radical operation in this group of patients with reduced injury rate. In this article we present a clinical case of surgical treatment of a 65-Year-Old female patient with primary hyperthyroidism caused by retrosternal parathyroid adenoma located in the aortic-pulmonal window. Preliminary diagnosis was based on Chest Computed Tomography (CCT scan) and technetium-99mTC scintigraphy. Considering complex anatomical and topographical location of the tumour it was decided to perform a thoracoscopic parathyroidectomy. The postoperative period was uneventful, with the laboratory values of parathormone being within reference range after the surgery. On the third day after the operation the patient was discharged. Further follow-up has not shown any signs of relapse.

Aim of clinical case presentation. To evaluate potential of intraluminal endoscopy for the treatment of diverticulitis, complicated by paracolic abscess. Summary. The clinical case of complicated colonic diverticula treatment by intraluminal endoscopy is presented. Patient at urgent admission was diagnosed to have “strangulated postoperative ventral hernia”; however the complex laboratory and instrumental investigations revealed inflammatory infiltrate in the right iliac area with signs of abscess formation. Attempts to carry out abscess drainage under ultrasound control were unsuccessful. To rule out potential neoplastic disease and determine the scope of surgical intervention videoassisted colonoscopy was carried out that revealed ascending colon diverticulum as a cause for paracolic abscess. Results. Endoscopic procedure provided successful surgical intervention that resulted in adequate internal drainage of the abscess was subsequent resolution of inflammatory infiltrate and complete patient recovery. Conclusion. Internal endoscopic drainage of the paracolic abscess that developed on the background of colonic diverticulitis can be successful alternative to urgent surgery due to reduction of treatment cost and improvement of quality of life of patients.

AIM:To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU).MATERIAL AND METHODS:For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period.RESULTS:In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days.CONCLUSION:Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

AIM:To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction.MATERIAL AND METHODS:The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience.RESULTS:It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.

Aim of clinical case presentation. To evaluate potential of intraluminal endoscopy for the treatment of diverticulitis, complicated by paracolic abscess. Summary. The clinical case of complicated colonic diverticula treatment by intraluminal endoscopy is presented. Patient at urgent admission was diagnosed to have “strangulated postoperative ventral hernia”; however the complex laboratory and instrumental investigations revealed inflammatory infiltrate in the right iliac area with signs of abscess formation. Attempts to carry out abscess drainage under ultrasound control were unsuccessful. To rule out potential neoplastic disease and determine the scope of surgical intervention videoassisted colonoscopy was carried out that revealed ascending colon diverticulum as a cause for paracolic abscess. Results. Endoscopic procedure provided successful surgical intervention that resulted in adequate internal drainage of the abscess was subsequent resolution of inflammatory infiltrate and complete patient recovery. Conclusion. Internal endoscopic drainage of the paracolic abscess that developed on the background of colonic diverticulitis can be successful alternative to urgent surgery due to reduction of treatment cost and improvement of quality of life of patients.

The results of treatment of 84 patients with different acute surgical diseases, complicated peritonitis, surgical tactic of conduct of which foresaw application of programmed relaparotomy are presented in the article. On the basis of comparative analysis of results of application of traditional methods of closure of abdominal cavity with variants considering decompression of abdominal cavity it is exposed, that the change of quantitative indexes of pressure in abdominal cavity in patients with decompressive wound closure substantially differed from the dynamics of intra-abdominal pressure in the control group. Monitoring of this index in the basic group of research was characterized the reliable progressive decline of intra-abdominal pressure in relation to an initial level with a minimum value before completion of cycle of sanation of abdominal cavity. In addition, frequency of complications in the group with the traditional closure laparotomic wound was for certain higher, with that, a third of developing complications were related to the problems of wound healing after frequent interferences on the background of intra-abdominal infection.

A new possibility to manage intra-abdominal pressure in this severe category of patients is introduced into actively discussing theoretical and practical conception of intra-abdominal hypertension development during peritonitis. This makes it possible to prevent effectively and combat the known negative multiple organ effects of intra-abdominal hypertension. This possibility is realized with the help of synthetic patch of porous polytetrafluoroethylene, implanted in the wound of patients with peritonitis using the tactics of programmed relaparotomy. The practical result of its first application in complex treatment of patients with peritonitis is the absence of complications are well known in using programmed relaparotomy and high survival rate of this very severe category of patients.

In work results of application of various variants polytetrafluoroethylens films for closing laparotomy wounds under the conditions of an experimental peritonitis are presented. It is authentically established that probability of occurrence of complications at implantation polytetrafluoroethylens films under the conditions of peritonitis have a straight line dependence from the size of a micro pores and features of technological processing implants

В работе представлены результаты применения различных вариантов политетрафторэтиленовых пленок для закрытия лапаротомной раны в условиях экспериментального перитонита. Достоверно установлено, что вероятность появления осложнений при имплантации политетрафторэтиленовых пленок в условиях перитонита имеет прямую зависимость от размера микропор и особенностей технологической обработки имплантата.

Three models of an intrabelly hypertension, («liquid», «gas» and «edematous») for studying efficiency of various variants of decompression, the grants directed on pressure decrease in an abdominal cavity are developed. The technique of reproduction intrabelly hypertension is presented, lacks and advantages of each model are estimated.