The article examines the role of robot-assisted technologies in modern surgery and medical rehabilitation. Their integration into clinical practice has led to changes in the spectrum of surgical interventions, the development of new types of operations and rehabilitation protocols, and has also influenced the conceptual framework and clinical rhetoric used by specialists.

Diffuse coronary artery disease is a complex clinical problem that requires an individual approach to the choice of treatment tactics. The technique of stimulation of extracardiac myocardial vascularization “YurLeon” from a minimally invasive approach is a promising alternative for patients with severe diffuse coronary artery disease and high surgical risk, who cannot undergo complete myocardial revascularization. This article presents comparative results between surgical treatment tactics (YurLeon technique) and conservative therapy (OMT) in patients with diffuse coronary artery disease.
Aim: to evaluate the clinical effectiveness of minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method) in patients with coronary heart disease and diffuse coronary artery disease in comparison with conservative treatment.
Materials and methods. The prospective study included 63 patients with diffuse coronary artery disease, 41 (65,1%) men, 22 (34,9%) women, aged 65 to 80 years, average age 74.03±3.2 years, who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic of the N.I. Pirogov National Medical and Surgical Center of the Ministry of Health of the Russian Federation. Patients were divided into two groups: Group I (n = 21) – minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method); Group II (n = 42) – conservative therapy. The functional class (FC) of angina, echocardiography, single-photon emission computed tomography of the myocardium synchronized with ECG, and quality of life indicators (HeartQol questionnaire) were assessed.
Results. After 12 months, in group I, compared with group II, there was a decrease in FC III-IV angina (group I – FC III from 76.2% to 42.9% (p _{(group I)} = 0.008), FC IV from 23.8% to 4.8% (p _{(group I)} = 0.045); group II – FC III from 81.0% to 85.7% (p _{(group II)} = 0.157), FC IV from 7.1% to 2.4% (p _{(group II)} = 0.157), (p _{(groups I-II)} = 0.003)) and a significant increase in FC II angina in group I – FC II from 0% to 42.9%, (p = 0.027); an increase in the left ventricular ejection fraction (EF) in group I from 30[28-33]% to 39[35-43]% (p_{(group I)} <0.001) compared to group II EF from 33[30-36]% to 37[37-41.75]% (p_{(group II)} <0.001), (p_{(groups I-II)} = 0.042). According to myocardial scintigraphy data, a decrease in the volume of hibernated myocardium was noted in group I from 25[20-35]% to 9[7-15]% (p_{(group I)} <0.001) compared to group II – from 15[12-18]% to 15[12-20]% (p_{(group II)} = 0.076), (p_{(groups I-II)} <0.001). In the observed patients, after 12 months, the quality of life indicators according to the PF (physical subscale) of the HeartQol questionnaire differed: in group I from 1.00 [0.90-1.60] points to 1.80 [1.10-1.90] points (p _{(group I)} <0.001), in group II from 1.00 [1.00-1.40] points to 1.25 [1.00-1.58] points (p _{(group II)} <0.012), (p _{(groups I-II)} = 0.004).
Conclusion. Based on the data obtained, it can be concluded that minimally invasive stimulation of extracardiac myocardial vascularization (YurLeon method) in patients with coronary heart disease and diffuse coronary artery disease with reduced myocardial contractile function improves the clinical condition of patients, provides high quality of life indicators, increases left ventricular EF and allows for additional blood supply to the myocardium in the late postoperative period.

Introduction. Stenting of bifurcation lesions of the coronary arteries requires constant adaptation to the challenges of modern interventional cardiology. Objective. To study the long-term results of surgical treatment of bifurcation lesions of the coronary arteries using a modified provisional stenting technique. Materials and methods. 90 patients with bifurcation lesions of the coronary arteries were divided into 3 groups by simple randomization. In two groups, provisional stenting was performed using classical techniques (side branch dilation and proximal optimization; kissing dilation with proximal optimization), in the third group, a modified technique was used – local postdilation of the stent cell with proximal optimization. One year after the intervention, angiographic parameters were studied using OCT control, as well as the incidence of deaths, acute cerebrovascular accidents (CVA), stent or arterial thrombosis, re-stenting of vessels, myocardial infarction, and major adverse cardiovascular events (MACE). Results. Myocardial infarction was detected in 6.6% of patients in each group. The need for repeated revascularization of the target vessel was observed in 10% of patients in the first group, 13.3% in the second, and 6.6% in the third group; repeated revascularization of another vessel was performed in 6.6% of patients in the first and second groups, and 3.3% in the third. Adverse cardiovascular events (MACE) occurred with an acceptably low frequency: in 13.3% in the first and second groups, and in 10% of patients operated on using the modified technique. No statistical differences were found between the groups in terms of angiographic parameters; however, lower values were observed in the third group when assessing restenosis in the main and side branches, late lumen loss in the OB, and total lumen loss in the bifurcation. In addition, the minimum diameter of the main branch was slightly higher in the modified technique group. Repeated OCT monitoring after 12 months showed acceptable values of the minimum vessel size. Conclusion. The described technique showed acceptable long-term results in the treatment of bifurcation lesions of the coronary arteries and can be considered as an alternative to classical, generally accepted stenting techniques.

Aims: to compare the efficacy and safety of mitral valve (MV) prosthesis using different surgical accesses (median sternotomy and lateral thoracotomy) in overweight patients; to evaluate the influence of the choice of access on complications, quality of life, survival and cardiac function, as well as to determine the risk factors for complications in combined surgical treatment of coronary heart disease and MV prosthesis.
Methods: Patient groups were formed depending on the type of surgical access: 50 patients underwent MV prosthesis through median sternotomy, and 80 patients underwent MV prosthesis through lateral thoracotomy. The study design was a retrospective cohort study. Surgical interventions were performed between 2015 and 2023. 130 overweight patients (BMI >30 kg/m2 ) with MV lesions were included in the analysis. Quality of life before and after surgery was assessed using the standard SF-36 questionnaire. Operative risk was assessed using Euroscore II scale, comorbid background was evaluated using Charlson comorbidity index. Statistical methods were used to analyze quantitative features: Student’s t-test, Mann-Whitney test, and mixed general linear models.
Results: The use of lateral thoracotomy, in comparison with median thoracotomy, contributed to a more pronounced reduction in pain intensity and improved quality of life in most of the parameters assessed by the SF-36 questionnaire, including physical, lifestyle, social and emotional functioning, as well as physical pain, general health and vitality.
Conclusion: According to the results of the study, MV prosthesis using lateral sternotomy can be considered as a preferable method in overweight patients, as it is characterized by shorter duration of surgery, artificial circulation, artificial ventilation, and duration of hospitalization. Both types of access provide pronounced improvement of hemodynamic parameters and reduction of the functional class of chronic heart failure according to NYHA without statistically significant differences between the groups. However, when combined surgical treatment of ischemic heart disease is necessary, the choice of access should be based on the assessment of the risk of progression of the underlying chronic kidney disease.

Rationale: Multilevel atherosclerotic lesions of the lower extremity arteries are most commonly associated with the development of critical ischemia. Despite the prevalence of lesions of several arterial segments, there is no clear algorithm for performing revascularization operations. The choice of treatment tactics and the type of reconstructive surgery is still insufficiently reflected in the literature. Evaluation of the results of revascularization operations depending on the initial anatomy of the lesion of peripheral arteries and the state of the outflow channel in order to preoperative predict the effectiveness of revascularization became the basis for this study.
Objective: to evaluate the results of revascularization operations in patients with multilevel atherosclerotic lesion of the arteries of the lower extremities, depending on the state of the peripheral outflow channel and deep femoral artery.
Materials and methods: The study was retrospective in nature and was conducted on the basis of the Department of Vascular Surgery of St. Petersburg State Medical Institution “City Multidisciplinary Hospital №2”. The study included 236 patients observed in the department between 2013 and 2024, of whom 179 patients were re-hospitalized. All patients had a multi-stage lesion of the arteries of the lower extremities. All patients were assessed in points of the outflow tracts proposed by R.B. Rutherford in 1997, with changes by A.V. Pokrovsky as modified by L.A. Maslov.
Results: The results of revascularization were studied depending on the nature of the surgical intervention performed and the condition of the deep femoral artery for 132 months in groups of patients with low (less than 5.0 points) and high (more than 6.0 points) peripheral resistance of the outflow channel outflow tract.
Conclusions: The revealed clear relationship between the level of peripheral vascular resistance and the results of reconstructive operations allows us to recommend the optimization of hemodynamic conditions of the outflow channel to improve the patency of vascular structures.

When analyzing 171 medical records of patients of the Pirogov Center who underwent open heart surgery (coronary artery bypass grafting, valve replacement) in 2023–2024, it was found that during treatment (the average hospitalization period in a surgical hospital is 10.9±0.6 days), the average hemoglobin concentration decreases to 91.8±2.2 g/l in women and 100.9±2.5 g/l in men.
The need for blood transfusion developed in 73.8% of women and 31.8% of men. 28.7% of patients received hardware reinfusion of autologous red blood cells, which in 53% of cases allowed to avoid allogeneic transfusion. 96.5% of patients received tranexamic acid and 22.2% – iron preparations. It is advisable to include the use of blood components, blood salvage and other patient blood management technologies in clinical guidelines and the standard of medical care for adult cardiac surgery patients. 

Currently, the main radical surgery for hepatocellular cancer and extensive metastatic damage to one half of the liver is an extended hemihepatectomy. In which up to 70% of the liver volume is removed. However, the remaining volume of liver tissue may be functionally insufficient. Liver failure develops rapidly in these patients, which is the main cause of postoperative mortality. On the other hand, with a decrease in the volume of hemihepatectomy, the radicality of operations may suffer.
In order to prevent tumor recurrence during extended hemihepatectomy, we successfully used the method of intraoperative cryotherapy on the wound surface of the remaining part of the liver, which was used in 29 patients with hepatocellular carcinoma. In 9 patients, operations were performed without cryotherapy. It should be emphasized that in all 38 cases, during hemihepatectomy, it was not possible to move more than 15 mm away from the edge of the tumor. The analysis of long-term results showed that the use of cryotherapy significantly reduced the number of patients with tumor recurrence.

Rationale: Vascular injuries are the main cause of mortality and disability in military and civilian injuries. With a massive influx of wounded, there is no time for hightech and long-term operations. The search for new effective ways to increase the viability of a limb segment damaged with an artery for transporting the wounded to the next stage of medical care seems extremely relevant.
Objective: to develop a technique for regional perfusion and preservation of the pelvis and lower extremities, followed by their inclusion in the systemic circulation, as well as to conduct preclinical tests of the developed method on laboratory animals (female minipigs).
Materials and methods: An experimental study was conducted on four minipigs, females weighing 40±5 kg each and aged 4–8 months. Perfusion and preservation of the pelvis and lower extremities, followed by their inclusion in the systemic circulation in experimental animals, was performed according to an original, independently developed technique. During the procedure, invasive monitoring of blood pressure, heart rate, control of diuresis, acid-base state in arterial blood was performed, neuromyography of the muscles of the lower extremities, Doppler sonography and pathoanatomical examination of tissue samples of a laboratory animal at time points were performed.
Results: In all four cases of the experiment, the planned surgical intervention was successfully performed and completed. There were no changes detected by Doppler sonography after the start of blood flow in the previously disabled anatomical segment. The amplitude of the bioelectric activity of the muscles before switching off from the systemic circulation, as well as 30 and 60 minutes after switching on the previously isolated anatomical segment did not differ. The assessment of histological changes in the striated muscles of the isolated anatomical segment, as well as liver, lung and kidney tissue after the inclusion of the disconnected segment in the systemic circulation showed the absence of necrobiotic changes in tissues and the absence of signs of reperfusion damage in the kidneys, liver and lungs.  
Conclusion: The use of isolated perfusion before preservation and subsequent washing of the contour of isolated perfusion before including the anatomical segment in the systemic circulation avoids the development of reperfusion injuries. The developed technique is safe and effective, allows you to maintain the viability of the pelvic and limb muscles for 5 hours and can be used in clinical practice.

Backgraund: One of the common complications of GI is mechanical jaundice. This complication is accompanied by a high mortality rate.
Aims: to reduce the risk of complications of cholelithiasis by restoring the outflow of bile from the liver as soon as possible and selecting antibacterial therapy.
Materials and methods: 366 patients without cholangitis clinic and without increased amylase levels were analyzed. The patients were divided into 3 groups: the first – patients with prolonged use of antibacterial therapy, the second – patients with short–term use of antibacterial therapy, the third - patients who underwent endoscopic manipulations.
Results: the results of the comparative analysis indicated that only the combined use of each of the groups leads to a favorable outcome in patients with cholelithiasis.
Conclusions: the study confirms that combined treatment, taking into account bacteriological analysis and the special clinical circumstances of patients, can significantly improve outcomes and reduce mortality. Future research should focus on optimizing antibiotic therapy regimens to improve their effectiveness and safety.

Background: The relevance of the problem of intestinal insufficiency in patients with consequences of spinal injury is becoming increasingly interesting in the practice of a multidisciplinary team of doctors dealing with this cohort of patients. Neurogenic dysfunction of the intestinal tract leads to many pathological conditions associated with intestinal insufficiency, but the acute period of traumatic spinal cord disease is largely characterized by hypoproteinemia, lipoproteinemia, vitamin deficiency, deficiency of minerals, electrolyte compounds, amino acids, mono- and disaccharides. At the same time, the processes occurring in the intestinal wall membranes in patients with consequences of spinal injury have not been sufficiently studied to date.
Objective: To study the features of metabolic processes in the mucous membrane of the small intestine in the first hours after spinal injury.
Materials and methods: In an acute spinal cord injury experiment involving laboratory animals – Wistar rats (n = 20), the dynamics of metabolism in the small intestinal mucosa was studied.
Results: The mucous membrane of the small intestine in the acute period of spinal injury had a hypercatabolic direction of metabolic processes, characterized by a decrease in the average fluorescence lifetime (tm) and a progressive increase in the relative contributions of the short and long attenuation components (a1/a2).
Conclusion: The acute period of traumatic spinal cord injury is characterized by metabolic disturbances in the small intestinal mucosa. A decrease in the average weighted survival time (tm) and an increase in the percentage contribution of the short component (a1) at each time interval under study confirms the hypercatabolic and hypermetabolic direction of metabolic processes without significant histological changes in the small intestinal mucosa. The results obtained can serve as a starting point in understanding the necessary composition, caloric content, and time of administration of enteral nutritional mixtures used to maintain homeostasis in patients with spinal cord injury. 

Rationale: the use of intravenous immunoglobulin (IVIG) in various diseases accompanied by immune deficiency, as well as autoimmune disorders, is an important component of the complex treatment of patients, allowing to achieve improvement of clinical symptoms, and in some cases to achieve recovery.
Objective: to identify patterns of IVIG infusions in a multidisciplinary hospital, to assess the compliance of IVIG use with the standards of medical care.
Methods: retrospectively, based on the materials of 44,221 electronic medical records, we studied the administration of IVIG to patients of the Pirogov Center hospital in 2024. Infusions of 2.5%, 5% and 10% IVIG solution (CSL, Switzerland) were performed. The content of immunoglobulin in 1 bottle is 2.5 and 5 or 10 grams. The diagnosis, gender, age, actual and ideal body weight, length of hospitalization, patient treatment outcome, amount and mode of immunoglobulin administration, serum immunoglobulin G, M, and A concentrations at the first administration were assessed. The data were studied using descriptive and inductive statistics at a significance level of 0.05.
Results: IVIG was administered to 52 patients (0.1%): 29 women and 23 men aged 51.8±14.2. There were no fatal outcomes. The hospital stay was 20.8±18.1 days. These patients received 90 immunoglobulin infusions during 64 hospitalizations. 44 infusions were administered to women, who were, on average, 10.9 years younger and 15.8 kg lighter than male recipients. There were no gender differences in the length of hospitalization, serum immunoglobulin concentrations, or infusion parameters. The patient’s body weight directly correlates with the amount of IVIG administered. The IVIG dose per 1 kg of body weight inversely correlates with the actual body weight, but is not associated with the ideal body weight. The ideal body weight inversely correlates with the IgM concentration and with the IVIG dose per 1 kg of ideal body weight. In addition to the above-mentioned relationship between IgM and ideal body weight, the concentrations of immunoglobulin classes do not correlate with any other studied parameters or with each other. Using the laboratory information system, 10 inpatients with minimal IgG concentrations (from 1.25 to 2.57 g / l) were identified in 2024. Seven of them received IVIG, and three others did not receive it due to the lack of clinical indications or transfer to outpatient treatment.
Conclusion: ln 2024, 0.1% of inpatients of the Pirogov Center received IVIG. In total, patients received 1935 grams of IVIG, or, on average, about 32 grams of immunoglobulin per patient. The evidence-based regimen of hemotransfusion therapy (including plasma and cryoprecipitate transfusion) allows more than 90% of donor plasma to be used for drug production. Replacing the actual weight of an adult patient with the ideal weight in the instructions for use of IVIG will reduce the administered dose by 10%.

Purpose: to improve the results of surgical treatment of soft tissue gunshot wounds caused by modern combat wounding agents taking into account the prognostic factors of traumatic disease course.
Methods: the results of complex treatment of 112 patients with soft tissue gunshot wounds were analyzed. From them 83,9% of the injured had combined and multiple gunshot wounds. The study included the wounded, in whom the area of the wound channel or damage amounted to 10 cm² , after primary surgical treatment at the previous stages of medical evacuation. Traumatic (wound) disease was diagnosed in 39 (34.8%) wounded.
Result: purulent-septic complications were diagnosed in 88% of the investigated patients. All the victims were treated by complex general clinical and local treatment with observance of the basic principles of surgical interventions (initial surgical debridement, second surgical debridement), vacuum-aspiration therapy and medicamentous application of modern water-soluble ointments in the I phase and ointments on regulated osmotic basis in the II phase of the course of the wound process. Pathogenetically substantiated multicomponent intensive therapy was required for 47 wounded, who received antibacterial treatment, immunotherapy, antibacterial detoxication, replenishment of protein-energy and water-electrolyte disorders. Complicated course of the wound process was noted in 13% of the victims, there were no lethal outcomes.

The multicenter study was conducted in the period from 2014 to 2024 in civilian medical institutions providing surgical care to civilians who received gunshot wounds as a result of military operations. The study was conducted on 40 male patients who gave their consent to participate in the study at the age of 35±6 years. All patients were divided into two groups. The first, the main one, consisted of 20 people who were treated for gunshot peritonitis, which developed as a result of a shrapnel wound to the abdomen with intestinal damage. The second, for comparison, consisted of 20 patients operated on for peritonitis caused by acute appendicitis. Both groups were comparable in age, gender, and severity of the condition. As a result of the study, it was found that patients with peritonitis, which developed as a result of a gunshot wound to the abdomen, have a large range of opportunistic pathogens. At the same time, a number of features were revealed, as associations of microorganisms prevailed, which were detected in 94,8% of cases. Another feature of the microflora in gunshot peritonitis was that in the vast majority of cases they were resistant to antibacterial therapy. The presence of these factors undoubtedly had a negative impact on the immediate postoperative period, leading to the development of complications in 45% of cases, which in 25% of cases led to sepsis and death of patients. All this must be taken into account when treating patients with gunshot peritonitis.

This study is based on the results of a retrospective analysis conducted to restore the shape and size of mammary glands in patients after radical mastectomy. When comparing the three groups of patients, depending on postoperative complications, it was found that the probability of developing specific complications of mild, moderate and severe degree in the group using the method of transplantation of own adipose tissue was lower compared with the groups using the two-stage reconstruction method expander implant and TRAM flap (p>0,05).
When analyzing the results of the BREAST-Q questionnaire survey in the postoperative period, a more significant improvement in the quality of life and greater satisfaction with the result of reconstructive surgery were revealed in the group of patients with the method of transplantation of their own adipose tissue (p<0.05).
Based on the results of the study, it was concluded that the monomethod of breast reconstruction through transplantation of own adipose tissue can be considered the method of choice in patients after mastectomy.

Introduction: chronic compartment syndrome (CCS) developed after surgical treatment of intermuscular phlegmon of the upper limb is a common pathology that has a significant negative impact on the quality of life of patients in the late postoperative period.
Objective: to develop an algorithm for the diagnosis and prevention of postoperative tissue hypertension (CTS) in patients with phlegmon of the upper limb.
Materials and methods: results of treatment of 134 patients operated on for intermuscular phlegmon of the upper limb (IMUP) (shoulder and forearm segments). Patients were divided into 2 comparable clinical groups, the difference between the groups was as follows: Group I – treatment using known technologies; Group II – treatment using original technologies (Patent of the Russian Federation № 2699964, № 2755388, № 2695367). They included diagnostics of tissue pressure, complex surgical treatment of compartment syndrome, prevention of myofascial dysfunction and postoperative tissue hypertension.
Results: аfter complex surgical treatment of the MFCI (shoulder, forearm) and compartment syndrome, chronic tissue hypertension may persist, which can have a negative impact on the patient’s quality of life with its clinical manifestations. In the postoperative period, it is necessary to monitor tissue pressure in order to determine the tactics of combating it.
Conclusions: The developed algorithm for the prevention of tissue hypertension has proven its effectiveness and can be recommended for use in purulent surgery departments.

The aim of the study was to evaluate the results of diagnosis and treatment of patients with diverticular colon disease (DBTC), complicated by perforation into the free abdominal cavity, with the development of widespread peritonitis.
Materials and methods. 115 patients were treated in the State Clinical Hospital of the NSR of Vladimir from 2014–2024 with DBTC complicated by widespread peritonitis. There were 72 men (62.6%) and 43 women (37.3%). The average age of the patients was 56.2±11.3 years. Ultrasound of the abdominal cavity was performed in 92 (80%) patients, abdominal X-ray in 85 (73.9%) cases, CT of the abdominal cavity in 32 (27.8%) patients, diagnostic endovideolaparoscopy was performed in 25 (21.7%) patients. All patients were operated on. The fatal outcome was recorded in 10 (9%) cases.
Results: 38 (33%) patients were admitted within 24 hours of the disease, 54 (47%) 24–72 hours and 23 (20%) more than 72 hours. In 65 (57%) ultrasound observations, sigmoid diverticula were detected. In 43 (38%) patients, there is free gas in the paracollar tissue. In 25 (22%) cases, blurring of the outer contour of the diverticulum was noted. In 15 (13%) patients, free gas was diagnosed on abdominal X-ray. The most effective diagnostic methods for this pathology were: MSCT and diagnostic laparoscopy, which in 98% of cases allowed to establish the correct diagnosis. Obstructive resection of the sigmoid colon according to Hartmann was performed in 71 (62%) cases. Complications occurred in 2 (2%) cases. Mortality in this subgroup is 5 (5%) patients. Obstructive resection of the descending intestine according to the Hartmann type was performed in 15 (13%) patients. There were no complications in this subgroup. Left-sided hemocolectomy with a single-stem colostomy was performed in 6 (6%) cases. Complications occurred in 2 (2%) patients. Obstructive resection of the sigmoid colon according to Hartmann + laparostomy was performed in 15 (13%) cases. In 7 (6%) cases, a vacuum-assisted laparostomy was formed after the main stage of the operation. 4 (4%) patients had a fatal outcome. Left-sided hemicolectomy with single-stem colostomy+laparostomy was performed in 8 (6.9%) patients. In 3 (2.6%) cases, a vacuum-assisted laparostomy was formed. In 1 (0.8%) case, a fatal outcome occurred against the background of progression of multiple organ failure, abdominal sepsis and septic shock.
Conclusion: The complicated course of DBTC has become the most important problem of urgent surgery. The issue of the treatment of patients with perforation of the diverticula of the colon in conditions of widespread peritonitis and severe abdominal sepsis remains relevant. The greatest diagnostic value in this category of patients are: computed tomography with intravenous contrast and diagnostic laparoscopy. Obstructive resection of the colon with perforation of the diverticulum is the operation of choice for widespread purulent and fecal peritonitis, which allows to eliminate the source of peritonitis, sanitize the abdominal cavity and reduce the degree of intoxication of the body. including in severe, comorbid and gerontological patients.

Varicose veins of the lower extremities can cause a significant decrease in the quality of life and may lead to serious complications. Due to endovenous revolution in the treatment of varicose veins and widespread introduction of thermal and non-thermal ablation methods, not only the results of treatment have improved, but also the quality of life of patients has dramatically increased. In this article, the treatment satisfaction assessment is carried out in patients who have undergone various modalities of endovenous ablation. Treatment satisfaction assessment is an important tool for patients to perceive their personal experience of interventional treatment. Accordingly, the best indicators of patient satisfaction were observed after glue ablation.

 Colorectal cancer (CRC) is the fourth most common cancer in the world and the third most common cause of death from cancer. The incidence of CRC increases with age. According to available literature data, comorbidity increases the risk of complications in surgical treatment of CRC (for example, according to some data, the incidence of anastomotic leakage in patients with comorbid diseases increases by 82%, and there is also an increase in 30-day postoperative mortality in the first 30 days to 6.0%). In this regard, it is necessary to develop certain approaches (comprehensive examination of patients at the preoperative stage, decision on the formation of a primary anastomosis and preventive intestinal stoma) to the prevention of postoperative complications in this group of patients.

The constant increase in the incidence of malignant neoplasms of the pancreas forces researchers to continue searching for the most effective methods of their diagnosis and treatment. The structure of ductal adenocarcinoma is found in 80-90% of all exocrine tumors of the pancreas. A key component of the diagnosis is the determination of further treatment tactics. A screening method for diagnosing pancreatic cancer is multispiral computed tomography. Radioimmunochemical tests of blood serum for 2 antigens – carbohydrate antigen (CA 19-9), cancer embryonic antigen are of practical importance among laboratory parameters.
Currently, systemic chemotherapy for pancreatic cancer is ineffective: the response to treatment is observed in less than 20% of patients, with a median life expectancy of about 6 months. However, studies by a number of authors have proven that adjuvant treatment, including chemotherapy and radiation therapy, increases long-term survival.
The current trend in pancreatic surgery is to move away from radicalism towards organ-preserving modifications of total duodenopancreatectomy, pancreatoduodenal resection. The problem of treating pancreatic cancer should be solved by combining the principles of selective choice of interventions, as well as determining clear indications for them. The search for new markers of pancreatic cancer screening, increasing the availability of radiation research methods, and the search for new chemotherapy drugs are promising. The search for reasonable options for reconstructive anastomoses remains relevant, allowing to preserve the physiological integrity of the body and, as a result, reduce mortality and the frequency of postoperative complications.

Pulmonary embolism is a common and life–threatening disease that develops under the influence of multiple triggers - predisposing factors. Their detailing in different groups of patients makes it possible to more effectively prevent and diagnose the pathology in question. This article presents the result of the study and analysis of modern ideas about the risk factors of pulmonary embolism in women at different age periods. At a young age, from 18 to 44 years old, there is a relationship between venous thromboembolic complications and conditions that increase the level and activity of estrogens (taking oral contraceptives, pregnancy, the use of assisted reproductive technologies, the presence of hormone-dependent neoplasms), the presence of thrombophilia and obesity. In women over 45 years of age – with the presence of concomitant diseases and the use of hormone replacement therapy. All of the presented predisposing factors significantly increase the likelihood of developing pulmonary embolism in patients of the corresponding age periods, and their combination makes this risk even higher.

Rationale: burn disease is a pathological condition leading to the disruption of organ and system functions, necessitating the development and implementation of comprehensive approaches to treatment and rehabilitation. The relevance of this issue is determined by the high prevalence of complications, significant rates of disability, and challenges in providing effective rehabilitation for patients with burn injuries.
Objective: to analyze modern methods of rehabilitation for burn patients, including physiotherapy, the use of biomaterials, psychological support, innovative technologies such as 3d bioprinting and telemedicine, as well as to substantiate the necessity of a multidisciplinary approach and personalized rehabilitation strategies.
Methods: the study is based on an analysis of domestic and international literature published between 2018 and 2023. Specialized scientific databases, including pubmed, scopus, and elibrary, were utilized. The analysis included high-evidence studies focused on the application of modern rehabilitation methods in burn injury treatment.
Results: data on the use of physiotherapeutic methods, including therapeutic physical training and elastic taping, innovative materials such as hydrogel dressings, and 3d bioprinting technologies for wound healing improvement were analyzed. The effectiveness of telemedicine in patient monitoring and adjustment of rehabilitation measures was reviewed. The importance of cognitive-behavioral therapy in reducing anxiety and depression levels in burn patients was highlighted. The significance of digital technologies, such as virtual reality, in alleviating pain and restoring motor functions was emphasized.
Conclusion: comprehensive rehabilitation for burn patients requires the integration of a multidisciplinary approach, innovative technologies, and personalized treatment methods. The application of modern technologies, such as hydrogel dressings, 3d bioprinting, and telemedicine solutions, enhances treatment outcomes but necessitates further research to standardize methods and improve their accessibility.

. Low-intensity chronic inflammation due to adiposopathy in visceral obesity is considered the basis for the formation of metabolic syndrome and an important component of the pathogenesis of leading non-infectious chronic diseases. The well-known anthropometric indicators of visceral obesity used in routine practice do not take into account the ectopic locations of fat depots and their contribution to the metabolic activity of adipose tissue. The search continues for universal integral indicators, including anthropometric, biochemical parameters, and the results of imaging studies reflecting early metabolic disorders in adipose tissue dysfunction. Early verification of metabolic changes associated with visceral obesity can significantly affect the prognosis of metabolic diseases and their complications.

The aim of the work was to summarize the best practices in using local negative pressure therapy in the context of treating patients with diabetic foot syndrome (DFS) in comparison with traditional treatment methods. Due to the high incidence of diabetes mellitus in the Russian Federation and the increase in purulent-necrotic complications, the medical community continues to work on optimizing the treatment of DFS. However, insufficient attention is being paid to the active study of some scientifically proven methods of adjuvant therapy. One of the effective methods of local treatment is vacuum therapy. The method has undergone significant changes in the last decade and has found wide application in various fields of medicine, opening a new era in the treatment of wound injuries. In this regard, the analysis of scientific and research papers devoted to the study of the mechanism of action and the possibility of using local negative pressure in patients with DFS has been carried out. As one of the elements of complex treatment, it has a high value, especially in cases of a lack of plastic material when closing a defect, when traditional methods of local treatment are ineffective. The results of the study can serve as a basis for the development of new clinical recommendations and improvement of existing protocols for the management of patients with DFS.

A clinical case of a rare disease in the world – a true aneurysm of the facial artery is presented.

A clinical case of successful treatment of a patient with purulent sternomediastinitis that developed in the immediate postoperative period after performing cardiac surgery is presented. Early diagnosis of this formidable complication was carried out by performing multispiral computed tomography with 3D reconstruction. In the complex treatment of sternomediastinitis, the main role was played by stage-by-stage surgical treatment of wounds using vacuum therapy and topical application of epidermal growth factor. A clinical recovery has been achieved while maintaining a high level of quality of life for the patient.

The article presents a completed clinical case of treatment of a 43-year-old patient with medial right-sided gonarthrosis and concomitant anterior cruciate ligament failure, who underwent simultaneous monocondylar endoprosthetics using a movable insert and autoplasty of the anterior cruciate ligament. At the end of the follow-up period, an excellent result was obtained on the KOOS scale and the patient fully returned to his usual physical activities.

Freiberg-Köhler disease most commonly affects the head of the second metatarsal. The etiology of the disease is currently not fully understood, and there are no uniform approaches to treatment tactics. This article presents a clinical case of successful surgical treatment of Freiberg-Köhler disease using shortening osteotomy of the metatarsal bone, microfracture of the head and replacement of the cartilaginous defect using a collagen membrane allograft.

An incarcerated femoral hernia is a pathology that an emergency surgeon often encounters. In the domestic medical literature, there are isolated reports of cases of acute appendicitis with a femoral hernia. The article provides a detailed description of this pathology. The presented example demonstrates the features of the symptoms, the difficulties that arise in the differential diagnosis of this disease, and also describes one of the possible options for surgical intervention.

The purpose of the study is to show the possibility of successful surgery using anexample of a clinical case of megadolichocolon in an adult,complicated by acute intestinal obstruction.
Patients and methods.The results of emergency surgical treatment of a megadolichocolon in a 43 – year-old man were reviewed.
Results. An ileostomy did not relieve intestinal obstruction with megadolichocolon. It is necessary to perform a radical colectomy.
Conclusion. Colectomy is an effective method of treating megadolichocolon complicated acute intestinal obstruction in adults.

In this article, we will briefly describe the life and achievements of Professor Vasily Alexandrovich Ratimov, who made a significant contribution to the development of maxillofacial surgery.