INTRODUCTION Treatment of gastrointestinal bleeding in patients receiving anticoagulant and antiplatelet therapy is an extremely complex and urgent problem. The risks of recurrent bleeding in such patients are extremely high, while the effectiveness of standard methods of treating gastrointestinal bleeding in this category of patients is lower, compared to the general population. The above served as a prerequisite for this study.MATERIAL AND METHODS In the period from 2020 to 2023, 362 patients receiving antiplatelet or anticoagulant therapy were treated for gastrointestinal bleeding at the O.I. Filatov City Clinical Hospital. All patients underwent endoscopic examination of the gastrointestinal tract, with primary endoscopic hemostasis required in 126 patients (34.8%). Endovascular embolization of the vessel — the source of bleeding. Risk factors for death, need for surgical intervention and recurrence of bleeding were analyzed. The sensitivity and specificity of the Rockall and Glasgow–Blatchford scales for assessing the risk of recurrence of bleeding and the need for surgical intervention in this category of patients were studied.RESULTS Anticoagulant therapy was statistically significantly associated with an increased risk of death. Among the risk factors for death, COVID-19 infection, age over 75 years, and arterial hypertension were statistically significant. Endovascular hemostasis demonstrated the greatest effectiveness embolization , the frequency of recurrent bleeding in this intervention was 5.7%, versus 32.5% in endoscopic interventions. The prognostic significance of the Rockall and Glasgow– Blatchford scales according to the results of our study was insufficient.CONCLUSION The results of the study are consistent with the data of the world literature. It is necessary to take into account the high efficiency of endovascular embolization in this category of patients when choosing a hemostasis method. Risk factors associated with a fatal outcome also do not contradict the generally accepted concept. At the same time, the feasibility and objectives of using current prognostic scales in such patients require further study.Patients over 75 years of age receiving anticoagulant therapy, as well as patients with COVID-19, have a lower risk of death, which must be taken into account when treating such patients (p<0.01).The appropriateness of using the Rockall and Glasgow–Blatchford prognostic scales in this category of patients is low, as evidenced by the low area under the curve (AUC) for the Rockall scale (0.6) and for the Glasgow–Blatchford scale (0.48).

Currently, the issue of coronavirus infection COVID-19 remains extremely relevant, and the SARS-CoV-2 virus also affects the gastrointestinal tract, and in some cases, coronavirus infection can be complicated by gastrointestinal bleeding. Up to 13% of COVID-19 patients have this complication. At the same time, the issue of determining risk factors for the development of gastrointestinal bleeding in patients with COVID-19 remains unresolved in the world literature. There is no single standardized approach to the treatment of gastrointestinal bleeding in patients with COVID-19. The above reasons served as prerequisites for this literature review. The purpose of the literature review is to establish risk factors and groups for gastrointestinal bleeding in patients with a new coronavirus infection, and to determine current and effective methods of treating this disease.

OBJECTIVE:To analyze the results of thoracoscopic esophagectomy for benign esophageal diseases.MATERIAL AND METHODS:The study included 78 patients who underwent thoracoscopic esophagectomy between 2011 and 2019. Peptic and burn strictures of the esophagus were diagnosed in 53 patients, achalasia - in 24 patients. Minimally invasive esophagectomy and esophagoplasty with isoperistaltic gastric tube and esophagogastrostomy on the neck was performed in 68 patients, Ivor Lewis esophagectomy - in 1 patient, coloesophagoplasty - in 9 patients. We used manual technique of anastomosis in 58 patients, stapling device - in 19 patients. In 1 case, surgery was finished with esophagostomy and gastrostomy.RESULTS:Mean blood loss was 200 ml (10-1200), surgery time - 450 min (265-765 min). Early postoperative complications occurred in 37 patients including anastomotic leakage in 24 cases. In long-term period, anastomotic strictures developed in 9 patients. No mortality was observed.CONCLUSION:Minimally invasive esophagectomy for benign esophageal diseases ensures favorable clinical outcomes. However, no consensus in the choice of surgical approach and indications, as well as small number of these patients cause challenges in implementation of this technique. There are different opinions regarding technique of anastomosis on the neck and surgical access in thoracoscopic esophagectomy.

Treatment of patients with chemical burns of the esophagus and stomach is a difficult task.Perforation of the stomach or the formation of strictures of the esophagus, stomach, duodenum, and even the initial parts of the jejunum can be the outcome of chemical burns.Patients with concomitant esophageal and gastric strictures are the most difficult to treat, which often requires multi-stage operations.This article describes a clinical case of surgical treatment of a patient with a combined chemical burn of the esophagus and stomach with hydrochloric acid. One week after hospitalization, the patient had gastric perforation. The patient was urgently operated in the course of peritonitis. The peculiarity of the operation was that the surgeons, having made a gastrectomy, removed the esophageal stump to the anterior abdominal wall in the epigastrium and applied an enterostomy. In such a state with significant alimentary depletion (body mass index — BMI 15) on 11.10.02 the patient was taken to a Moscow clinic. A year later, the main surgical reconstructive treatment was performed — retrosternal bypass esophagoplasty of the right half of the large intestine and the terminal ileum in the isoperistaltic position, as well as extirpation of the esophagus. As a result of long-term treatment and several surgical interventions, a good short-term and long-term result was obtained.

PRO (patient reported outcomes) is a patient's subjective assessment of health and quality of life, without interpretation by a specialist. PROM (patient reported outcomes measure) questionnaires are used to analyzing this data. Assessment of the quality of life is a perspective direction, which allows to improve the quality of medical care and treatment results. Today, there are many questionnaires PROM, their reliability and validity has been proven in numerous studies. Unified standards and methods for developing and evaluating questionnaires have been developed. Interest in the use of quality of life questionnaires is increasing constantly. However, studies analyzing the data of the PROM questionnaires are rarely found in the national literature. Quality of life is also poorly researched in clinical practice. The aim of the literature review is to present modern methods for assessing the quality of life of patients, especially with cancer. A review of the most widespread and reliable questionnaires and assessment instruments for the quality of life of a patient has been carried out. The analysis of world experience of their use in clinical practice, for patients with cancer has been performed. Examples of both general and specific questionnaires are given. PROM questionnaires are widely used among patients with cancer. However, incorrect use of PROMs is found in the literature, and in patients with certain nosologies PROM data studied poorly. Further analysis of the potential of PROM questionnaires implementation is required, as well as their translation and adaptation for use in Russian health care.

Aim. To reveal and evaluate opportunities of preoperative computer tomography (CT) for pancreatic fistula (PF) prediction after pancreatoduodenectomy. Materials and methods . In 2005 International Study Group on Pancreatic Fistula (ISGPF) developed grading criteria for PF, including asymptomatic biochemical (Grade A), that could be treated conservatively, and clinically relevant (Grade B, Grade C), with consecutive active surgical treatment. For now ISGPF definition of PF is widely accepted. We review the literature since 2005 for original articles in English describing quantitive assessment of the pancreatic parenchyma using CT with histological validation. Low sample trials (<10 cases) were excluded. Results. Three original publications met the inclusion criteria. Fatty and fibrosis infiltration of the pancreatic parenchyma assessed by preoperative CT revealed statistically significant correlation with PF rate. Conclusion. Preoperative CT offers accurate prediction opportunities for postoperative pancreatic fistula and may help caregivers to set up protocols for a strict and early detection of warning clinical signs, to tailor the clinical management of different risk classes, or to select high-risk patients who might be excluded from surgical resection. This would also improve patient selection for relevant research protocols and facilitate a more definitive assessment of collected data related to surgical outcomes, across different institutions and surgeons, and even among different surgeries, in either single-institution or multi-center trials that involve pancreatic surgery.

Aim. To reveal and evaluate opportunities of preoperative computer tomography (CT) for pancreatic fistula (PF) prediction after pancreatoduodenectomy. Materials and methods . In 2005 International Study Group on Pancreatic Fistula (ISGPF) developed grading criteria for PF, including asymptomatic biochemical (Grade A), that could be treated conservatively, and clinically relevant (Grade B, Grade C), with consecutive active surgical treatment. For now ISGPF definition of PF is widely accepted. We review the literature since 2005 for original articles in English describing quantitive assessment of the pancreatic parenchyma using CT with histological validation. Low sample trials (<10 cases) were excluded. Results. Three original publications met the inclusion criteria. Fatty and fibrosis infiltration of the pancreatic parenchyma assessed by preoperative CT revealed statistically significant correlation with PF rate. Conclusion. Preoperative CT offers accurate prediction opportunities for postoperative pancreatic fistula and may help caregivers to set up protocols for a strict and early detection of warning clinical signs, to tailor the clinical management of different risk classes, or to select high-risk patients who might be excluded from surgical resection. This would also improve patient selection for relevant research protocols and facilitate a more definitive assessment of collected data related to surgical outcomes, across different institutions and surgeons, and even among different surgeries, in either single-institution or multi-center trials that involve pancreatic surgery.

57 В настоящее время в хирургии и онкологии четко отмечается тенденция к увеличению доли операций, выполняемых лапароскопическим и торакоскопическим способами. Вмешательства, которые осуществляются с применением этих технологий, определяются термином «минимально инвазивная хирургия», или «minimally invasive surgery (MIS)», который является общепринятым во всем мире. Наибольшее количество торакои лапароскопических операций производится при лечении больных со злокачественными поражениями органов желудочно-кишечного тракта. В то время как при раке пищевода, желудка, толстой кишки методика операций с применением MIS отработана достаточно четко, для новообразований пище водножелудочного перехода единого общепризнанного подхода к лечению не существует. Это касается в первую очередь выбора операционного доступа и методики формирования пищеводных анастомозов. Тем не менее увеличение частоты встречаемости опухолей пищеводно-желудочного перехода обусловливает возросший интерес к MIS в лечении кардиоэзофагеального рака (КЭР). Первыми применили MIS в лечении КЭР бельгийские хирурги R. Costi и соавт. [1], которые в 2004 г. впервые осуществили резекцию пищевода и кардии из лапароскопического доступа. Спустя 1 год подобную операцию осуществили P. Baccari и соавт. [2] у пациента с поражением дистального отдела пищевода. https://doi.org/10.17116/onkolog2019801157

The post-traumatic diaphragmatic hernia is a rare type of trauma which most commonly occurs after the blunt trauma of the thorax and abdomen. In the acute period of trauma, the symptoms of the emergency diseases and nonspecific signs of the diaphragmatic rupture are the reasons of frequent diagnostic mistakes. A missed diaphragmatic rupture grows in time and leads to migration of organs from the abdominal cavity to the thoracic one due to pressure gradient. The symptoms of diaphragmatic hernia are not expressed and the duration of the asymptomatic period of the disease may vary from some years to 10 years and longer. The increasing restructuring of the abdominal wall leads to reduced abdominal cavity, which makes the standard reconstructive surgery difficult, the intraabdominal pressure grows and relapse occurs in the postoperative period. In these cases, surgeons perform complex techniques which enlarge the abdominal cavity with local tissues or an artificial graft. However, there are no clear recommendations about the extent of the abdominal wall reconstruction so that the abdominal cavity size would be adequate for organs. The authors suggested a simple method to calculate it and used it in practice. In the article, we report the clinical case of a 53-year-old woman with a giant post-traumatic diaphragmatic hernia after motor vehicle accident 48 years ago and offer an original method of treatment. The first operation including hernia resolution and repair of diaphragmatic rupture was complicated by relapse on the second day after operation due to the high intra-abdominal pressure. During the second reconstructive surgery (4 months later), the authors performed their own method of abdominal cavity enlargement and got a good result in the shortand long-term postoperative period.

The post-traumatic diaphragmatic hernia is a rare type of trauma which most commonly occurs after the blunt trauma of the thorax and abdomen. In the acute period of trauma, the symptoms of the emergency diseases and nonspecific signs of the diaphragmatic rupture are the reasons of frequent diagnostic mistakes. A missed diaphragmatic rupture grows in time and leads to migration of organs from the abdominal cavity to the thoracic one due to pressure gradient. The symptoms of diaphragmatic hernia are not expressed and the duration of the asymptomatic period of the disease may vary from some years to 10 years and longer. The increasing restructuring of the abdominal wall leads to reduced abdominal cavity, which makes the standard reconstructive surgery difficult, the intraabdominal pressure grows and relapse occurs in the postoperative period. In these cases, surgeons perform complex techniques which enlarge the abdominal cavity with local tissues or an artificial graft. However, there are no clear recommendations about the extent of the abdominal wall reconstruction so that the abdominal cavity size would be adequate for organs. The authors suggested a simple method to calculate it and used it in practice. In the article, we report the clinical case of a 53-year-old woman with a giant post-traumatic diaphragmatic hernia after motor vehicle accident 48 years ago and offer an original method of treatment. The first operation including hernia resolution and repair of diaphragmatic rupture was complicated by relapse on the second day after operation due to the high intra-abdominal pressure. During the second reconstructive surgery (4 months later), the authors performed their own method of abdominal cavity enlargement and got a good result in the shortand long-term postoperative period.

Extirpation or subtotal resection of esophagus was performed in 14 patients by using of thoracolaparoscopic technique in terms from November 2011 to March 2014. The mean patients' age was 56 years old (27-67 years). In 10 patients indications for surgery included benign esophagus diseases such as cardiospasm stage IV (2 cases), peptic stricture (5 cases) and burn stricture (3 cases). 4 patients were operated for esophagus cancer including middle one-third cancer in 1 patient, lower one-third cancer in 3 cases. 10 patients underwent extirpation of esophagus with peristaltic gastric tube plasty. 1 patient had esophagus substituted by segment of the left colon. Esophageal anastomoses were formed on the neck (interrupted sutures were applied in 7 patients; staplers - in 3 cases). Lewis operation with intrapleural esophageal-gastric anastomosis forming was performed in 3 patients. The mean surgery duration was 579 minutes (305-710 min), mean blood loss - 141 ml (from 50 to 300 ml). Postoperative period had not complications in 8 of 14 patients. Different complications including partial failure of the anastomosis on the neck (5 cases), intrapleural anastomosis failure (1 case) were observed in 6 patients. Partial failure of the anastomosis on the neck was treated by using of therapy. All patients recovered. Patient with intrapleural anastomosis failure required additional surgery which included uncoupling of anastomosis, esophagostomy on the neck and gastrostomy forming. This patient died from recurrent myocardial infarction. Thus the authors consider that complete thoracolaparoscopic technique provides precise preparation of esophagus and stomach, adequate lymphadenectomy with minimal blood loss and operative trauma. The results after these operations are comparable with those after open interventions. Thoracolaparoscopic simultaneous operations must be applied in clinics having sufficient experience in esophagus surgery and thoracolaparoscopic technique.