The author's article presents the results of analysis stapleless and stapler use gastric bypass for morbid obesity with the BAROS system. This system allows us to study not only the loss of excess body weight, but also to assess the dynamics of the pathology associated with obesity, as well as subjectively assess changes in the quality of life of the operated patients.

As a result of the application of the three-component analysis system, good results were found in both compared groups without.

The aim of the research: To determine the level of effectiveness and justification of stenting of the main pancreatic duct in the modern surgical practice, in order to prevent the development and treatment of acute pancreatitis, in particular, complicated forms of acute pancreatitis, postoperative acute pancreatitis and severe forms of acute pancreatitis.

Materials and methods: An analysis of various domestic and foreign medical literary sources that have information and data from their own and third-party research on the treatment and prevention of acute pancreatitis by stenting the main pancreatic duct was made, including articles, monographs, journals and textbooks for students of higher educational institutions and residents.

The results of the study: A literature review revealed that the vast majority of sources indicate a positive effect of stenting of the main pancreatic duct on the treatment and prevention of acute pancreatitis, including with severe postoperative course and the presence of complications. However, in some clinical situations, this method requires risk weighing. For instance, stenting in the presence of a significant area of pancreatic necrosis, together with the inexperience of the operating surgeon, can worsen the prognosis of a favorable outcome or lead to even greater complications from the pancreas.

Conclusion: The analysis shows that stenting of the main pancreatic duct in the treatment and prevention of various forms and degrees of acute pancreatitis leads to a significant decrease in the incidence and number of deaths, which indicates the high justification and effectiveness of using this method in modern surgical practice. In order to achieve the greatest possible success and prevent immediate and long-term complications, it is necessary to carefully consider all risk factors and analyze each clinical case in detail.

A 60-year-old man admitted to the clinical center due to weakness, episodes of jaundice. The laboratory date revealed elevated levels of total bilirubin - 112.5 µmol/l (range 8,5-20,5 µmol/l) and direct bilirubin - 60.8 µmol/l (range 4,3-4,6 µmol/l), elevated hepatic enzymes (aspartate aminotransferase [AST]: 95 U/l (range ≤ 40 U/L), alanine aminotransferase [ALT]: 301 U/l (range ≤ 30 U/L). When performing esophagogastroduodenoscopy, a polyp of the large duodenal papilla with a spread to the terminal parts of the bile and pancreatic ducts was revealed, and a biopsy was taken. Diagnisis: "Tubulovillous adenoma of the major duodenal papilla with epithelial dysplasia II-III". Complications: "Multiple choledocholithiasis. Mechanical jaundice. Liver failure." Surgery: laparoscopic duodenotomy, papillectomy, choledocholithotomy, performing of choledochoduodenal anastomosis, duodenoplasty and abdominal drainage. The postoperative period was taking its normal course. Polyps of the large duodenal papilla are relatively rare form of tumors of the gastrointestinal tract, which may not manifest clinically, or, as the above case, lead to severe pathological conditions. Currently, there is no single approach to the treatment of this group of diseases. Some authors propose a pancreatoduodenal resection, but the risks of this operation associated with high postoperative morbidity and mortality are not always justified. The case is unique because the described procedure is less invasive and affects the minimum number of organs. Laparoscopic approach has significant advantages in the treatment of this infrequent pathology.

Aims: assessment of the safety of early closure of temporary ileostomy in patients with rectal cancer after the total end partial mesorectal excision.

Materials and methods: participants: patients of our clinical centers were examined with CT-proctography or rectoscopy to check whether bowel anastomoses were intact on 8-th day after the primary surgery. Patients with intact anastomoses who fulfilled the inclusion criteria were randomized to 2 groups: the first group, (n=37) with early closure of ileostomy (day 8-13 after stoma formation) and the second group (n=39) with deferred closure (after 12 weeks). It was expected that early closure would be a safe procedure.

Results: 76 participants were randomized; results of their treatment were analyzed. Time boards of reconstructive surgery do not result in terms of postoperative complications (8.1% in 1-st group versus 7.7% in control, p=0,08, not significant). However duration of reconstructive surgery in the group with the early closure of ileostomy was shorter (Tm in 1-st group = 51 min (28-127) versus 70 min (30-135) in second group, duration of surgery in intervention group was shorter in 1,37 times that one in control group (95% CI 1,28-1,46, p=0,02)).

Conclusion: early closure of ileostomy in patients after surgery for rectal cancer is feasible and doesn’t result in an increase the number of postoperative complications; it may be considered as an alternative to deferred closure. However, this problem should be studied in greater depth to evaluate both complications associated with ileostomy and the quality of the life.

Abstract: laparoscopic antireflux surgery are becoming more frequent tool in the treatment of gastroesophageal reflux disease (GERD). In this case, according to the literature, symptoms of dysphagia in the postoperative period arise again in 3-30% of patients, which leads to the fact that 3-6% of them are operated repeatedly.

The aim of research: assessment mechanisms for recurrence of GERD and the ability to perform adequate surgical correction after primary antireflux surgery.

Materials and methods: the team of authors during the period from 1993 to 2018 operated on 2,678 patients for GERD and hernia of the esophageal aperture of the diaphragm (GVAP). 127 (4.74%) patients underwent surgery for recurrent form of the disease, 46 from their initial operation is performed in other clinics.

Results: the median follow-up of re-operated patients was 63 months (12 to 139 months). A satisfactory functional result was achieved in 76.4% of the reopened patients.

The aim of the study was to study the development of MACE in the early and distant period after endovascular treatment.

Materials and methods. The study included 270 patients (216 men, 54 women) with acute coronary syndrome. Depending on the treatment, patients are divided into three groups. In group 1 (n = 110) - with emergency percutaneous intervention supplemented by thrombospiration for a responsible heart artery infarction without thrombolytic therapy; Group 2 (n = 70) - with emergency emergency transdermal intervention supplemented with thrombospiration on a heart attack artery with prehospital thrombolytic therapy; group 3 (n = 90) - with emergency percutaneous intervention on a heart attack artery, without thrombolytic therapy and without thrombaspiration .

Results. Major cardiovascular complications in the entire group without thrombospiration in the early and long term.