Aim. To determine the risk of sarcopenia development and progression in bariatric patients after laparoscopic longitudinal gastric resection and after laparoscopic gastric bypass surgery.
Methods. A comprehensive analysis was conducted, incorporating modern scientific literature and clinical guidelines to identify challenges in the diagnosis, treatment selection, and postoperative management of such patients. The study involved 30 patients, each of whom underwent a standardized preoperative outpatient assessment. This assessment included anthropometric measurements, as well as general and biochemical blood tests (such as blood glucose, total protein, albumin, and a lipid profile). To assess the degree of sarcopenia, a method involving computed tomography (CT) scanning of the head and neck was selected.
Results. The BMI of the two groups being compared showed no statistical differences, with averages of 37.2 kg/m² and 40.6 kg/m², respectively. At follow-ups conducted 3, 6, and 12 months after surgery, both groups exhibited satisfactory weight loss results. Among the 15 patients who underwent laparoscopic sleeve gastrectomy, sarcopenia was detected preoperatively in 6 patients (40 %), while the remaining 9 patients (60 %) showed no signs of sarcopenia. However, 12 months post-surgery, signs of sarcopenia were observed in 8 out of 15 patients (53.4 %).
Conclusion. Bariatric surgery induces significant changes in body composition, affecting not only fat mass reduction but also leading to a decrease in skeletal muscle mass. The progression of sarcopenia was more pronounced in patients who underwent laparoscopic gastric bypass surgery compared to those who had laparoscopic sleeve gastrectomy. Therefore, patients undergoing bariatric surgery may be at increased risk of developing or exacerbating sarcopenia.

Aim. To conduct a comparative analysis of the dynamics of healing of gunshot and domestic wounds in the purulent-infected stage, depending on the wound coating used.
Methods. The study examined the treatment outcomes of 30 patients with gunshot and household purulent-infected soft tissue wounds, treated during a special operation in the Donetsk region of Donbass. Among these patients, those with gunshot wounds were military personnel involved in active combat. The gender distribution was 7 women (23 %) and 23 men (77 %), with a mean age of 42.5 years [range: 33.59 to 75 years]. The average Body Mass Index (BMI) of the patients was 27 kg/ m² [range: 25.35 to 28.15 kg/m²].
Results. When comparing the patient groups, notable differences in wound healing rates were observed. The group with the highest healing rate showed significant progress, with wounds healing by 80.7 % by day 15 and 95.8 % by day 30. Another group, which underwent a similar treatment method, also demonstrated a high healing rate, albeit slightly lower: by day 15, wounds had healed by 71.6 % (3.1 % lower than the first group), and by day 30, the healing rate was 93.7 % (2.1 % lower). The groups with the lowest healing rates showed significantly slower progress, with healing rates of 52 % and 47.9 % on day 15, and 87 % and 81.5 % on day 30, respectively

Background. The incidence of disease relapse after primary antireflux surgical treatment ranges from 4 to 24 %, with up to 9 % of cases requiring revision surgery. Several studies demonstrate that the results of operations for recurrent hiatal hernia are less satisfactory compared to the primary procedure, especially after multiple interventions.
Aim. To propose a technique for laparoscopic redo fundoplication using a novel method, to evaluate short-term and long-term results after repeated surgical treatment of patients with recurrent hiatal hernia and GERD, and also to propose a classification of relapses of GERD and hiatal hernia.
Material and methods. The prospective study included data from 31 patients diagnosed with recurrent GERD and hiatal hernia. Laparoscopic redo fundoplication was used as a surgical method. Intraoperatively, technical errors of the previous operation were identified. The classification of relapses was conducted using the author’s method. Quality of life indicators using specialised questionnaires before surgery were: GERD-Q — 12.1 ± 2.82, GERD-HRQL — 26.12 ± 8.31, GSRS — 44.26 ± 10.21.
Results. There were no access conversions. The average duration of the operation was 141.21 minutes, blood loss was 81.40 ml, intraoperative complications in 4 (9.7 %) patients were eliminated intraoperatively, postoperative complications according to Clavien-Dindo ≥ 3 were diagnosed in one patient (pneumothorax), performed drainage of the pleural cavity. In 18 (58 %) patients, technical errors were identified that were made during the previous antireflux intervention. Quality of life indicators using specialised questionnaires six months after surgery were: GERD-Q — 2.1 ± 1.31, GERD-HRQL — 4.31 ± 2.98, GSRS — 17.02 ± 6.18. During the follow-up examination, 27 (87 %) patients noted complete recovery, as well as the absence of the need for PPI and prokinetic therapy.
Conclusion. The results of the study confirm the effectiveness, functionality and safety of laparoscopic redo fundoplication as the main treatment for this disease.

Aim. To analyse the results of surgical treatment of osteomyelitis in patients with diabetic foot.
Methods. A retrospective analytical study was conducted to assess the outcomes of surgical treatment for osteomyelitis in diabetic foot patients. The study analysed 28 patients with osteomyelitis classified as Grade III according to the Wagner classification. The average age of the participants was 62.5 ± 14.5 years, and the mean duration of diabetes mellitus was 8.2 ± 5.5 years. The cohort consisted of 16 men (67.1 %) and 12 women (32.9 %). All patients presented with a single osteomyelitic lesion located in the anterior region of the foot. The underlying causes of osteomyelitis included trophic ulcers and complications such as abscesses of the toes and phlegmon of the foot, which developed secondary to the trophic ulcers.
Results. In the group of patients who underwent both autopsy and drainage of abscesses and phlegmon, followed by one-stage amputation of one or more toes with radical resection of the corresponding metatarsal heads, the average number of hospital bed days was 31.9 ± 15.7. In contrast, the group of patients who were admitted without purulent necrotic complications and underwent one-stage amputation of one or more toes with radical resection of the metatarsal heads had an average of 13.4 ± 2.1 bed days.
Conclusion. Prolongation of medical treatment in patients with osteomyelitis of the diabetic foot, leading to the occurrence of purulent-necrotic complications, doubles the length of hospital stay, which entails an increase in treatment costs.

Aim. To analyze the use of biological factors in the stimulation of the wound healing process. In the course of the study, we analysed relevant domestic and foreign literature sources on the given topic.
Methods. The literature was reviewed using the key query ‘the role of biological factors in wound healing stimulation’ through the eLIBRARY and PubMed databases.
Results. Currently, the range of therapeutic approaches is broad and diverse, incorporating both traditional and experimental methods such as advanced dressings, tissue matrices, growth factors (GFs), cell therapy, and nanotechnology. The wound healing process is regulated by a complex interplay of intercellular, intracellular, and extracellular signalling mechanisms across various phases of healing.
Conclusion. The application of platelet-based therapies in different medical fields has shown promising outcomes in certain conditions, such as acute and chronic injuries of bone and cartilage. However, platelet-based preparations have yet to gain widespread clinical use. Several studies have demonstrated the involvement of platelets and related products, such as platelet microparticles (PMPs) and exosomes, in multiple phases of wound healing. The presence of a substantial number of biologically active molecules within platelet granules—exhibiting anti-inflammatory, angiogenic, proliferative, and other properties—renders platelets particularly attractive for use in regenerative medicine, including the stimulation of wound healin

Background. Although skin melanoma is a tumour which can be localised visually, its current diagnosis remains unsatisfactory. Skin melanoma exhibits an extremely diverse clinical presentation and a highly variable progression of the neoplastic process.
Aim. To analyze our experience in diagnosing metastatic melanoma of the gastrointestinal tract.
Materials and methods. The paper presents data from endoscopic and morphological studies of 29 patients who were diagnosed with metastatic melanoma with lesions of the gastrointestinal tract at the Department of Endoscopy the N. Blokhin National Medical Research Centre of Oncology.
Results. Among the patients there were 12 (41.3 %) men and 17 (58.6 %) women, whose average age was 50 and 53 years, respectively, the majority of metastatic lesions of the gastrointestinal tract were asymptomatic, only 4 (13.8 %) patients had the disease accompanied by complaints such as difficulty passing food, in 2 cases (6.9 %) episodes of gastrointestinal bleeding were detected. In 7 (24.1 %) cases, the source of metastasis was not identified. The features of the manifestation of metastatic melanomas include the frequently combined lesions of the oesophagus, stomach and duodenum. In rare cases, there is a combination of pigmented and pigmented forms of melanoma.
Conclusion. Given the high potential for regional metastasis, the ability of melanoma to disseminate through the skin, the occurrence of multiple metastases even in the absence of local growth, and its often asymptomatic progression in gastrointestinal organs, the diagnostic protocol should encompass the full spectrum of endoscopic techniques. This includes esophagogastroduodenoscopy and colonoscopy, utilizing advanced methods such as narrow-band imaging, magnification, or a combination of both. Biopsy samples should be taken for morphological, cytological, and immunological analysis. Additionally, comprehensive diagnostic methods such as immunoscopy should be employed.

Background: Foreign bodies in the rectum are among the rarest conditions encountered in emergency surgery and can have various etiologies.
Aim: To examine the patterns of injury, diagnostic methods, surgical options, and outcomes associated with foreign bodies of the rectum.
Materials and methods. A retrospective analysis was conducted on the treatment outcomes of 47 patients with rectal foreign bodies who received care at various surgical hospitals in the Khanty-Mansiysk Autonomous Okrug — Ugra from 2019 to 2023. The study examined factors such as sex and age distribution, etiology, duration of the treatment period, diagnostic features, and types of medical interventions. The results of treatment and length of hospital stay were also assessed. A criminal history was noted in only one patient (2.1 %). The insertion of a foreign body into the rectum for sexual pleasure was reported by 42 patients (89.4 %). Non-sexual causes were responsible for the condition in 4 patients (8.5 %).
Results. In the analysed group there were 29 (61.7 %) young people, 9 (19.1 %) middle-aged people, 8 (17.0 %) elderly people, and one (2.2 %) in the senior age group. The average age of the patients was 42 ± 13 years. There were 33 men (70.2 %) and 14 women (29.8 %). In the first 3 hours, 10 (21.3 %) people sought medical treatment, after 1—3 days — 34 (72.3 %) patients, and after 4 days — 3 (6.4 %) patients. In most cases, in 42 (89.3 %) patients, the foreign body was removed transanally. If transanal removal was impossible, laparotomy was performed in 5 (10.6 %) patients.
Conclusion. Sexual gratification was the most common reason for the insertion of a foreign body into the rectum. To prevent perforation and improve the prognosis of this pathological condition, timely diagnosis and treatment are necessary