Aim. To evaluate the role of endoscopic techniques in the diagnosis of neuroendocrine tumors of the rectum, as well as to determine the features and symptoms characteristic of these tumors.

Methods. An analysis of patients diagnosed with R-NETs examined at the N.N. Blokhin NationalMedical Research Center of Oncology over the past year and a half was conducted. The followingdata were established: the average size of the formations, their most common localization, theaverage proliferation index and the preferred method of treatment.

Results. The average follow-up period was 25 months. The median age was 47,5 years. All patientsunderwent colonoscopy using clarifying diagnostic techniques. In 57% of cases, tumors were localized in the middle ampullary section of the rectum, in 32% in the lower ampullary section, andin 11% in the upper ampullary section. The average size of the formations was 9 mm.According tothe results of histological examination, type 1 according to the WHO classification was identified in73% of cases, and type 2 in 27% of cases. All patients underwent surgical treatment. There wereno signs of disease progression at the time of evaluation of the results.

Conclusion. According to the latest data, there is currently no single tactic for managing patients with neuroendocrine tumors, and the existing diagnostic and treatment plan is a multidisciplinary comprehensive approach. The choice of an adequate volume of surgical intervention depends on the correct endoscopic assessment of the tumor, which allows suspecting the neuroendocrine nature of the formation before its removal. The widespread introduction of colonoscopy as a screening method allows increasing the detection rate of such rare formations as neuroendocrine tumors of the colon, as well as increasing the awareness of endoscopists in recognizing neuroendocrine tumors of the rectum.

Aim. Analysis of morphological changes in the mucous membrane of the gastrointestinal tract that developed against the background of COVID-19-associated pneumonia, accompanied by bleeding.

Methods. The study included 72 cases of erosive and ulcerative gastroduodenal bleeding with complicated Covid-pneumonia. The patients were treated at the University Clinical Hospital No. 4 of Sechenov Moscow State Medical University (Sechenov University) from April 2020 to March 2022.

Results. Morphological examination of biopsies from the gastrointestinal tract has provided irrefutable evidence of both direct and indirect effects of the SARS-CoV2 virus on cells of the gastrointestinal mucosa.

Conclusion. The gastric mucosa in COVID-19 patients is exposed to the virus, which leads to erosive and ulcerative changes in it, leading to bleeding. This is simultaneously facilitated by anticoagulant and anti-inflammatory therapy given to such patients. These complications must be anticipated and prevented in a timely manner.

Aim. to determine the effect of the volume of resection and the etiology of the disease on the risk of developing acute postresection liver failure (APN).

Materials and methods. The study included 43 patients who underwent surgery for bulky liver tumors. The prognosis for the development of acute postresection liver failure was calculated for all patients. According to etiology, patients are divided into 3 clinical groups. Group I – patients with liver echinococcosis, group II – patients with malignant neoplasms and group III – with benign tumors. Depending on the volume of liver resection, two groups were identified – IV and V. The fourth group consisted of 23 patients with resection of 1-2 liver segments, and the fifth group consisted of 20 patients who had 3 or more liver segments removed.

Results. With resection of 1-2 liver segments (group IV), the percentage of acute renal failure, regardless of the etiology of the lesion, was about 4%. In patients of the fourth group, with the removal of 3 or more segments, the risk of developing OPN was statistically significantly higher in patients with malignant neoplasms. In patients with malignant liver damage, the probability of developing acute renal failure increases to 15%, while in patients with liver echinococcosis and benign neoplasms with resection of 3 or more liver segments, the probability of developing acute renal failure does not exceed 7%.

Conclusion. The probability of developing acute renal failure does not directly depend on the etiology of the disease. With resection of 1-2 liver segments, the risk of acute renal failure is minimal, regardless of the etiology of the disease. With resection of 3 or more segments, the probability of acute renal failure in patients with malignancies is higher. In patients with benign tumors and with liver echinococcosis, the probability of acute renal failure did not differ significantly.

Aim. To study the possibilities of preventing the development of adhesions in clinical practice.

Methods. The present study analyzed current sources, both domestic and foreign literature on various ways of preventing the development of adhesions and the effectiveness of these methods.

Results. According to the definition of the Association of Surgeons, adhesions are a multifactorial pathological process based on various morphofunctional disorders of organs and body systems. Currently, there are several main ways to reduce the severity of the adhesive process: reduction of injury to the peritoneum, the use of drugs that affect the formation of fibrin and fibrinolysis, effective hemostasis, prevention of tissue drying and the use of barriers that prevent adhesions.

Conclusion. Despite the extensive knowledge of the pathophysiology of adhesions, strategies to address the problem of adhesions have not yet been developed. The methods discussed in this study, although promising, do not show results that would allow their widespread implementation in clinical practice.

Aim. to evaluate the advantages and disadvantages of SILS cholecystectomy, as well as to study the clinical aspects of this operation, substantiate its effectiveness and safety based on the results of the above studies, and compare the results of single port and four—port cholecystectomy.

Methods. To achieve these goals, an analysis of 33 English- and Russian-language publications on the topic «Endovideosurgery» was conducted. The criteria for selecting the articles on the basis of which the literary review was compiled were: relevance; correct statistical analysis of data (for statistical calculation, the authors resorted to the Mann-Witney U test, the T-test (Student’s criterion); detailed description of interventions, equipment for surgery. The information presented in the article corresponds to the current state of development of endovideosurgery.

Results. Based on the research results, such postoperative indicators as the severity of pain, the duration of rehabilitation of patients, satisfaction with the aesthetic effect after surgery, the frequency of ventral hernias and the duration of surgery were analyzed. To analyze the results, a comparative assessment was performed with respect to the parameters of classical four-port laparoscopic cholecystectomy. For the most complete understanding of single-access surgery, the presented work also highlights the most common complications of SILS cholecystectomy, and several other surgical interventions performed by single-port access.

Conclusion. It has been established that laparoscopic cholecystectomy from a single access is a promising low-traumatic method of treating gallbladder diseases. The main and probably temporary limitation for the widespread introduction of SILS cholecystectomy technology is the high cost of surgical instruments. However, advantages such as a comfortable and rapid rehabilitation period for the patient and a satisfactory cosmetic effect contributed to the evolution of surgical instruments for the widespread introduction of SILS technology.

Aim. Description of a clinical case of a rare genetic disease in a patient with Caroli C syndrome.

Methods. The paper presents data from the clinical history of the disease, data from laboratory and radiation research methods, and an analysis of the diagnostic path that led to the diagnosis of Carli syndrome in a patient who was treated at the Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan.

Results. Consideration of this clinical case allows us to define a step-by-step diagnostic algorithm that led to the diagnosis of Caroli syndrome. When choosing treatment methods, the team of authors came to the conclusion that there is no single treatment concept and decided on symptomatic therapy for this nosology. The patient was discharged 10 days after the start of treatment in a satisfactory condition. The peculiarities of this clinical case include the late onset of the disease.

Conclusion. Due to the extremely narrow degree of prevalence, the diagnosis of Caroli syndrome is a complex clinical task in patients with symptoms of cholangitis, cholangiolithiasis, mechanical jaundice, cholestatic variant of viral hepatitis B. The diagnostic search consists of many stages and requires the joint participation of specialists of different profiles. To date, there are only symptomatic treatment methods for Caroli syndrome, the only etiologically significant method of treating these patients is orthotopic liver transplantation.

Aim. To demonstrate the therapeutic and diagnostic capabilities of peroral cholangioscopy in the diagnosis and symptomatic treatment of primary sclerosing cholangitis.

Materials and methods. Due to the presence of undifferentiated stricture, according to instrumental examination methods, peroral cholangioscopy was performed in the presented case. The SpyGlass DS II (Boston Scientific) biliary tract endoscopic imaging system was used as a daughter device. Intraductal biopsy was performed using SpyBite Max forceps. Taking into account the visual picture of intrahepatic cholangiolithiasis, large stones, contact laser lithotripsy using a thulium laser was performed for curative purposes.

Results. Visual examination of the biliary tree and intra-flow biopsy confirmed the diagnosis of primary sclerosing cholangitis. The use of contact laser lithotripsy made it possible to carry out adequate drainage.

Conclusion. The peroral cholangioscopy technique allows for targeted biopsy of altered tissues under double (endoscopic and X-ray) control, is effective and relatively safe in the differential diagnosis of various lesions of the bile ducts.