Aim: To assess the efficiency of preemptive analgesia with Ketoprofen 100 mg 2 hours before procedure per os to decrease postoperative pain. 
Methods: This prospective, randomized, double-blind study was conducted in the surgical department of the Lomonosov MSU Medical Center. Patients who were diagnosed with anorectal disease without contraindication to perform subarachnoid anesthesia or other somatic diseases and underwent anorectal procedure were included. After signing the consent all participants were randomly divided: the first group got a 100 mg Ketoprofen tablet, the second one got a starch tablet 2 hours before surgery. Following the procedure the primary and secondary outcomes were evaluated: opioid administration intake, the pain at rest and during defecation, duration and frequency of other analgesics intake, readmission rate, life quality, time to return to previous lifestyle, the complications rate. 
Results: 134 participants were included in the study: 68 in the main group, 66 in the control one. Postoperative pain syndrome was statistically less in the main group on the 4,5,7 days (p=0,035; p=0,023; p=0,046, respectively). Opioid intake after surgery was significantly lower in the main group (p=0.174). The side effects frequency, live quality, time to return to previous lifestyle also didn’t differ in both groups. 
Conclusion: Preoperative analgesia is safe and effective in reducing postoperative pain in anorectal surgery, reduces the opioid usе, doesn’t increase the ketoprophen side effects frequency. It should be a part of the routine patients’ multimodal management in anorectal surgery.

Background: the most common surgical intervention for complicated forms of Crohn's disease is ileocecal resection. This operation is performed in a planned manner with the ineffectiveness of conservative therapy. Also, the operation is performed according to emergency indications with the development of intestinal obstruction or septic complications. In the vast majority of cases, it is possible to perform a laparoscopic approach, thereby reducing the risks of complications and accelerating the recovery of the patient in the postoperative period.
Aim: evaluation of the results of laparoscopic ileocecal resection in patients with Crohn's disease
Materials and methods: the study included 46 patients (21 women, 25 men) who underwent laparoscopic ileocecal resection for the stricture form of Crohn's disease. 18 patients were operated on for emergency indications, 28 – for planned indications. The mean age was 37.6 year.
Results: conversion to laparotomy was performed in 4 patients (8.7%). The mean operative time was 128.2 minutes. Complications that required reoperation were in 3 patients (6.5%). 4 patients (8.7%) had purulent-septic wound complications.
Conclusion: laparoscopic ileocecal resection for stricture Crohn's disease is a simple, easily reproducible operation, both in planned surgical interventions and in emergency cases.

Evaluation of the impact of carotid endarterectomy on the cognitive status of patients remains debatable, since patients with atherosclerotic lesions of the carotid arteries suffer from chronic cerebrovascular insufficiency, and changes in the cognitive status of patients after carotid endarterectomy may be due to factors such as increased blood supply to the brain, microembolism after the start of blood flow, and cerebral ischemia during cross-clamping and also the effect of various anesthesia drugs on the cognitive status in these patients is ambiguous.
Purpose. To assess age-related changes in cognitive status in patients with atherosclerotic lesions of the carotid arteries in the postoperative period
Material and methods. Neuropsychological testing was performed in 128 patients after eversion carotid endarterectomy, divided into age groups and depending on the methods of anesthesia: Propofol group and Sevoflurane group.
Results. In patients under the age of 60 years, there is an improvement in cognitive status in the early and late postoperative period, while in patients of the older age group, there is a slowdown in the progression of cognitive dysfunction in both groups of anesthesia.
Conclusion. An important criterion for evaluating the surgical prevention of cerebrovascular accidents is clinical effectiveness, in particular, the impact of operations and anesthesia methods on the cognitive sphere of patients of different ages with pathology of the main arteries of the head, which determines the quality of life not only for patients, but also for relatives.

A group of 9 patients, average age 62, with symptoms of urination disorders, who underwent surgical intervention for infravesical obstruction (IVO), were under observation. Patients underwent urodynamic examination in the volume of liquid static profilometry using a specialized standard 10F catheter before and after surgery. The urodynamic system of domestic production LEVELEST SURD-02 was used. Based on the data obtained, the reflex mechanism of pelvic floor tone was analyzed in patients with prostate adenoma operated by transurethral enucleation.

Urolithiasis is an urgent problem of surgical urology, about 200 thousand operations are performed annually in the Russian Federation. The complicated course of the postoperative period is accompanied by changes in homeostasis associated with immune activation and dysregulation of the endothelial system. The study evaluated the parameters of lymphocyte plasma membrane blebbing in patients with complicated and uncomplicated postoperative urolithiasis. 240 patients suffering from urolithiasis took part, who underwent surgical treatment. Patients were divided into two clinical groups: I clinical group (n = 130) – patients with a favorable course of the postoperative period of urolithiasis, II clinical group (n = 110) – patients with a complicated course of the postoperative period of urolithiasis. The control group was – 25 practically healthy persons. Lymphocyte membrane status was assessed by phase contrast microscopy. The maximum frequency of plasma membrane changes was recorded in patients with postoperative complications and amounted to 15.92 [13.20; 17.01] when evaluating initial blebbing and 21.93 [17.67; 30.45] for terminal blebbing. With a favorable course of postoperative period, patients with urolithiasis did not have statistically significant changes in the parameters of blebbing of the plasma membrane of lymphocytes.

The work is based on the analysis of the literature data on the problems of treating patients with metastatic pancreatic cancer, identifying a group of patients with more favorable treatment prognosis. The objectives of this review are to study diagnostic criteria, to determine the optimal algorithm for the diagnosis and treatment of patients with oligometastatic pancreatic disease. 
According to the Global Cancer Observatory (GLOBOCAN) in the world, in 2020 the incidence of pancreatic cancer among men and women was about 7.2 and 5.0 per 100 thousand, with a mortality rate of 6.7 and 4.6 %, respectively [1]. At the same time, in most cases, the disease is diagnosed at stage IIIIV, so the results of treatment remain unsatisfactory, 2/3 of patients die within 1 year after the diagnosis is made. The "gold standard" for the treatment of this group of patients today is only systemic antitumor therapy according to the FOLFRINOX regimen, in which the average overall survival is about 11.1 months. 
Thanks to the development of ideas about the mechanisms of tumor progression, the improvement of diagnostic methods and antitumor treatment, the concept of oligometastatic disease has appeared and is being actively studied. According to the current theory, this group of patients with stage IV tumors can potentially have a better prognosis. The analysis of modern domestic and foreign literature is carried out. According to scientific studies, careful selection and implementation of combined treatment can significantly increase the survival rate of this group of patients. Based on numerous studies, some authors have proposed optimal algorithms for the diagnosis and treatment of patients with oligometastatic pancreatic disease.

Chylothorax is a rare disease that occurs due to damage to the thoracic lymphatic duct with the outflow of chyle from the lymphatic system into the pleural cavity, usually on the right.
Establishing a final diagnosis for this disease is often associated with additional time costs, due to its relatively low prevalence. Currently, 65 scientific articles in Russian have been written on this topic.
A necessary condition for the successful treatment of this disease is the identification of the root cause of its occurrence with its subsequent elimination.
Despite the available scientific publications on this topic with a description of algorithmic approaches to diagnosis and treatment, sometimes, due to objective circumstances, it is necessary to correct these recommendations to ensure the most adequate treatment for a particular patient.

The clinical case presented in this article illustrates one of the serious iatrogenic complications of Nissen fundoplication: diaphragmatic eventration. A 65-year-old patient was diagnosed with recurrent paraesophageal hiatal hernia. Intraoperatively, it was treated as diaphragmatic eventration. Laparoscopic Nissen refundoplication, suturing of the diaphragm defect was performed. The patient was discharged in satisfactory condition on the 5th day.