The aim of the study was to research the functional state of the liver in the preoperative and early postoperative period after cholecystectomy in patients with acute cholecystitis complicated by obstruction of the vesicular duct with empyema or local peritonitis. 94 clinical cases of patients with acute calculous cholecystitis who underwent laparoscopic cholecystectomy were analyzed. All patients were examined with biochemical blood and urine tests, toxic substances test, markers of oxidative stress and antioxidant system also were determined.results: in the groups of patients with complicated inflammatory process in the gallbladder (empyema, peritonitis) the markers of the functional activity of the liver compared with those in non-occlusive cholecystitis were changed to a greater extent during the early postoperative period. A similar picture was revealed in the study of endotoxicosis in patients with acute destructive calculous cholecystitis. With the development of acute destructive calculous cholecystitis in pa-tients, the intensity of free radical processes of lipid peroxidation increased.Conclusion: in patients with acute destructive cholecystitis who underwent laparoscopic cholecys-tectomy, before the operation and in the early postoperative period (especially in the first two days) there is a violation of the detoxification and synthetic activity of the liver. More pronounced data of the disorder with occlusive destructive cholecystitis complicated by acute empyema, as well as destructive cholecystitis, complicated by the peritonitis, which aggravates the course of the early postoperative period.

Evaluation of the immediate and long-term results of esophagoplasty with pathomorphological analysis of the mucosa of the artificial esophagus.objective: to analyze the results of esophagoplasty in patients with scar narrowing of the esophagus and achalasia of the cardia.Material and methods: Between 1998 and 2018, 205 esophagoplasty was performed with scar narrowing of the esophagus and achalasia of the cardia. Long-term results were studied in 178 with the prescription of interference for more than 1 year (73 after esophagocoloplasty, 84 after esophagogastroplasty).results: Violations of the functioning of the colonic artificial esophagus, with the appearance of inflammation of the mucosa of the artificial esophagus, revealed during endoscopic examination and fluoroscopy of the artificial esophagus. Pathomorphological studies have revealed the reorganization of the epithelium of the artificial esophagus, which corresponds to the data of the endoscopic study. Inflammatory changes were detected in patients after coloplasty, atrophic and sclerosing in patients after gastroplasty.Conclusion: thus, the gastric stem is most suitable for esophagoplasty, according to the findings.

Over the past decade there has been a steady increase in the incidence of non-Hodgkin’s lymphomas. The primary lesion of the gastrointestinal tract is detected in 2/3 of the patients. The most common histological structure is B-large cell lymphomas that affect the stomach, small and large intestine. Most often, lymphomas that affect the intestine are revealed in men of working age. In 60-70%, non-Hodgkin’s lymphomas are complicated by obstructive intestinal obstruction, while intussusception is rare. This article describes the case of non-Hodgkin’s lymphoma of the ileum complicated by intussusception with intestinal obstruction.

Vaginal atrophy is one of the most frequent pathological conditions of women in peri and postmenopause and its manifestations negatively affect their quality of life.One of the most urgent problems of modern gynecology is changes in the genitourinary tract of women associated with the end of the reproductive period of life and its inevitable aging. To describe estrogen - dependent age - related changes affecting the external genitourinary system, vagina, urethra and bladder, a new term-genitourinary menopausal syndrome-GUMS (IMS, 2014) - was adopted by written vote. Pathogenetically justified therapy for any disorders associated with menopause, is the use of estrogens (IMS 2016). But in the arsenal of the clinician should be and non-drug means with comparable efficiency, in particular, hybrid two-wave fractional laser therapy.The aim of the investigation was to expand the possibilities of therapy for genitourinary syndrome based on clinical and morphological evaluation of the effectiveness of remodeling fractional laser therapy.Material and methods: The study was not comparative, independent, prospective, clinical-morphological study of 26 patients (n=26) aged 49.5±5 years, applied to the period between October 2017 and February 2018 for conservative treatment on the clinical database Department of obstetrics and gynecology with course perinatology RUDN University (Central clinical hospital №6 of Russian Railways) with a diagnosis of «Postmenopausal atrophic vaginitis» (No. 95.2) and who gave voluntary informed consent for inclusion in the study: obtain biological material to study the clinical, hardware and laboratory parameters, therapy, statistical processing and publication of the results. Diagnoses were confirmed clinically and based on laboratory and instrumental studies.Laser remodeling using the «Hybrid fractional laser vaginal diVaTM with a wavelength of nm 1470 /2940» in the system of the multi-platform JOULE followed all patients. Each patient in three stages - before laser therapy, 1 and 3 months after it - took two samples of vaginal tissue - from the front and rear walls. In total, there were 156 conducted research of the histological structure of the vaginal wall (26 patients * 2 BM * 3 phase) at the Department of pathological anatomy to I. M. Sechenov (Sechenov University) methods of microscopy (hematoxylin-eosin and Masson), immunohistochemistry, computer morphometry and study of expression of some genes by Polymerase-chain reaction-real time.results: GUMS is characterized not only by a decrease in the number of epithelial layers, but also by the thinning of the basal membrane, connective tissue and muscle compartment of the vaginal wall with a pronounced inflammatory reaction against the background of significantly reduced trophism, compaction, collagenization and disorders of architectonics. Even a single procedure is a hybrid fractional laser showed statistically significant changes, particularly manifested after 3 months: reduction reaction imunohistochemical Coll.I from 46.1±2.9 % of field of view to 29.5±1.1 (p<0.05) 3 months after laser procedure and inflammatory reaction by CD8+ marker, respectively, from 5.2±0.2 to 1.1±0.6 (p<0.05). The expression of the genes ECM1 and CD80 decreased significantly. Immunohistochemical reaction for the markers Coll.III, α-SMA, CK5, VEGF-a, as well as expression of genes MMP-1, 2, 3, 9, POSTN and CD163 increased significantly by 1.3-2.2 times (p<0.05). Histological changes were consistent with a significant improvement in the clinical picture in 22 out of 26 women of the studied cohort (84.6%).Conclusion: Remodeling under the influence of laser therapy affected the morphological and functional properties of all the components of the vaginal wall, not just the mucous membrane. Even without the estrogenic effects of increased trophic tissues, degraded compact arrangement of collagen fibers type I to replace them began to actively synthesize new collagen fibers type III increased the total number of microfilaments, recovered their orientation in space, decreased proinflammatory and increased preregenerative the activity of the fibroblasts stabilized before thinning basal layer of the epithelium. Our study, albeit on a small sample, showed reliable and versatile positive effects, which is quite important - long-term effects even from a single application of a hybrid fractional laser with the possibility of simultaneous use of ablative and non-ablative wavelength and rapid recovery after the procedure.

The aim of the study was to evaluate the effectiveness of complex treatment of peritonitis, including laparoscopic interventions and physiotherapeutic methods, in the prevention of adhesive disease of the abdominal cavity.Methods: The treatment of 120 patients with peritonitis was analyzed. The main group consisted of 50 patients who underwent laparoscopic (closed) abdominal sanitation with the irrigation and aspiration apparatus, followed by low-frequency ultrasound treatment of the abdominal cavity with Mesogel. The control group (n = 70) included patients who used an open method for treating diffuse peritonitis-programmed relaparotomy. Patients were monitored blood levels, endogenous intoxication, microflora composition.results: application of the proposed combined method of treatment of patients with peritonitis leads to normalize the parameters of cardiac activity (pulse), respira- tory organs - the rate of respiration and temperature earlier in comparison with the another group. Evaluation of the dynamics of the main indicators of the generala e-mail: eriken@yandex.rub e-mail: vap.61@yandex.ruc e-mail: nicolai.okunev@yandex.rublood test showed, that the number of leukocytes in the main group quickly comes to normal values. The results of microbiological analysis showed that in the main group the growth of microflora was not detected after the complex therapy, in the remaining patients the number of colony-forming units decreased several times, the sensitivity to antibiotics expanded. The dynamics of the indicators is a marker of therapy effectiveness, that leads to decrease severity of the patients of the main group after the treatment.Conclusion: Using the developed technique in the early postoperative period is noted a significantly better clinical and laboratory effect (more rapid correction of homeostasis disorders). Significant decrease in the formation of adhesions of the abdominal cavity was established. The results obtained make it possible to recom- mend a new method in the treatment of patients with peritonitis.

Today, there are a huge number of invasive treatments for choledocholithiasis, but there is no universal treatment that combines the advantages of mini- mally invasive endoscopic methods and laparotomy. With the accumulation of experience in laparoscopic operations, the advantages of an endovideoscopic method for the resolution of choledocholithiasis are increasingly convincing. The article contains descriptions of the currently available methods for resolving choledocholi- thiasis and the therapeutic algorithm for endovideososcopic treatment of choledocholithiasis developed by us.

Among all surgical pathologies inguinal hernias are quite common, their proportion is 4, 9%. The aim was to study the early and late postoperative period for complications in patients with classical TAPP-technique of hernioplasty with a group of patients, without fixing the mesh polypropylene endoprosthesis. The study included 140 patients of working age with an established diagnosis of inguinal hernia. The main group included 69 patients with TAPP-plasty without fixing the mesh polypropylene implant. The control group included 71 patients with classical TAPP - plasty of inguinal hernias with fixation of a reticular implant with the help of a herniostepler. After the operative treatment, the duration of the surgical intervention, the severity of the postoperative pain syndrome, the frequency and severity of postoperative complications, and the dose of injectable analgesic agents represented by the opioid derivative were compared. The study shows the effectiveness of the use of an unfixed modification of classical TAPP - hernioplasty.

Acute pancreatitis is characterized as a complex of morphofunctional changes in the stroma of the pancreas, and in parapancreatic fatty tissue, surround- ing organs and tissues, as well as manifestations of the syndrome of multiple organ dysfunction due to the activity of metabolites and enzyme toxemia, which in turn determines the clinical picture of the disease, as well as the risks of complications and high mortality rates. In xx century, the main peak of mortality were patients in the early phase of the disease, while at present to 80% of deaths related to the phase of the development of septic complications and multiple organ failure. In many respects, this trend is explained by the lack of unity of views on the etiopathogenesis of the disease, the difficulties of early diagnosis and the high frequency of diag- nostic errors, which entails a delay in the provision of specialized care to the patient. Another reason is seen in the development of multi-organ dysfunction, which aggravates the patient’s condition and, closing the vicious circle, leading to serious complications and fatal outcomes. One of the leading component of multiple organ dysfunction developing decompensated acute surgical pathology of the abdominal cavity and retroperitoneal space, should be considered as acute renal failure, as- sociated with high mortality isolated (78%), while engaging in decompensation three or more organ systems tends to the absolute. At the same time, the frequency of acute kidney damage becomes the leading problem in the treatment of such patients in recent years. Even in the case of a favorable outcome in the development of isolated or combined renal dysfunction in patients with pancreatic necrosis is a significant weighting of the rehabilitation period, prolonged phase of inpatient treatment and regularly raises its cost. At present, there has been a steady increase in the number of patients with severe forms of acute pancreatitis with acute kidney damage, especially in the working-age group. Not always satisfactory results of their treatment are the reason for further in-depth studies in this direction.

The article presents the literature data and the results of our own research concerning the violations of bone metabolism in the long term after bariatric operations. The study observed the parameters of bone metabolism in morbid obesity (MO), including the cases after bariatric interventions. The first group consist- ed of patients with a body mass index (BMI)> 40; the second group - patients who underwent bariatric interventions; the third (control) group is healthy people who do not have obesity and overweight. The three groups differed in the level of bone resorption markers and indicators of bone formation. In the course of the study, we found a tendency of prevailing of bone resorption processes among the patients with MO compared with the control group. There was also a sharp tendency towards the development of osteopenic conditions among the patients undergoing malabsorptive types of bariatric interventions, and no such pathology was revealed in the control group. The comparison of bone metabolism in the first and the second groups confirmed the tendency to develop osteoporosis among the operated patients, and in patients with restrictive type of bariatric interventions with minimal risk.