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Objective: To substantiate the safe timing and volume of enterolysis during operative treatment of patients with external small intestinal fistulas against the background of widespread peritoneal adhesive process.

Material and methods: Comparative results of treatment of 315 adult patients, divided into 3 groups (60, 74 and 181 patients), depending on the graduation of peritoneal adhesive process, timing of operations and volumes of enterolysis are presented.

Results: The highest postoperative mortality (17 (6.7%) out of 255) and the frequency of complications were characterized by operations performed within 1 month, against the background of widespread adhesive process. After 30 days, more favorable outcomes were observed in patients after complete distal enterolysis. The lowest mortality rate of patients (3 (2.4%) of 127) was observed more than 3 months after the onset of fistulas, after complete distal enterolysis.

Conclusion: The presence of widespread peritoneal adhesions worsens the outcomes in patients with external small intestinal fistulas; performing reconstructive operations within more than 3 months from the formation of fistulas and complete distal enterolysis improves treatment results.

As the standard of living improves, the incidence of diabetes, atherosclerosis and hypertension increases, which causes an increase in ischemic lesions of the arteries of the lower extremities. Clinical manifestations depend on the cause and the presence of the patient's underlying peripheral arterial disease. Treatment of lower extremity ischemia remains a challenge for vascular surgeons. For many years, the mainstay of treatment was surgical or catheter-based thrombectomy and bypass surgery. Later, thrombolytic therapy and percutaneous transluminal angioplasty became treatment options for some patient groups. Despite these advances in treatment, lower extremity ischemia is still associated with high rates of morbidity, mortality, and limb loss. Therefore, regardless of which treatment method is used, early diagnosis and prompt surgical intervention based on individual symptoms is essential, with the goal always being to reduce pain and improve blood flow to ultimately save the limb. When choosing a treatment option for lower extremity ischemia, the risks of a particular intervention relative to the patient's clinical condition must be weighed against the urgency and severity of the threat to the limb and the expected improvement in the patient's clinical condition. One of the modern technologies for endovascular surgical treatment of peripheral vascular disease is rotational atherectomy. Quite a large number of studies devoted to this technology have been conducted, but the results obtained confirming or questioning the effectiveness of innovative systems of rotational atherectomy at the present stage of vascular surgery development are still insufficiently generalized.

Objective: To summarize the review of modern studies, clarifying the obtained results of the effectiveness of innovative systems of rotational atherectomy in acute and chronic ischemia of the lower limbs.

It was clarified that Rotarex and Jetstream rotational atherectomy systems allow to effectively restore blood circulation in chronic thrombosis, including atherosclerotic and diabetic arterial lesions, which allows us to recommend them for further use in patients taking into account the indications and individual features of the course of ischemic limb lesions. Although various studies have proven the safety and efficacy of rotational atherectomy, there are limitations, so careful patient selection is required and further large-scale studies are needed.

Objective: To analyze the results of large postoperative ventral hernia repair using the Rives-Stoppa technique and posterior component separation between 2018 and 2023.

Material and methods: We retrospectively analyzed 55 case histories of patients with large postoperative ventral hernias. The Rives-Stoppa technique was used in 25 (45.5%) patients, posterior component separation - in 30 (54.5%) patients.

Results: The classical Rives-Stoppa technique was predominantly performed in women (mean age 67.3±1.2 years). In 20 (80%) patients, hernia defect did not exceed 14 cm. Mean wound drainage time was 3.8±0.7 days, mean postoperative in-hospital stay - 12.7±2.4 days. Posterior component separation was more common in men, whose age was significantly lower (58.4±2.0 years, U=160.500, p<0.001). This technique was significantly more common for hernia > 15 cm (14 (47%) patients, c²=4.288, p=0.038). Mean wound drainage time was 9.7±0.8 days, mean postoperative in-hospital stay - 18.8±1.6 days (p<0.001). In early postoperative period, 15 (27.3%) patients had wound complications. There was no significant difference in the incidence of wound complications (p=0.808), and no deaths were recorded.

Conclusion: A differentiated approach is necessary for large hernias. Some elderly and senile patients underwent Rives-Stoppa procedure. Posterior component separation is required for anterior abdominal wall reconstruction in young and middle-aged men. Posterior component separation significantly increases the wound drainage time and hospital-stay, but does not significantly affect the incidence of wound complications.

Objective: This study examines methods of treatment of pediatric patients with blunt splenic injury (BSI) in medical institutions in the city of Sevastopol and the Republic of Crimea. The effectiveness of non-operative management (NOM) in patients with BSI of varying AAST injury grade was assessed and risk factors which could predict the need for operative management (OM) were identified.

Material and methods: A two-center retrospective cohort study was performed, in which reviewed the medical records of children diagnosed with BSI between 1996 and 2023. A cohort of patients hospitalized since the start of the active use of NOM of BSI was identified to determine risk factors.

Results: The study included 112 patients. The mean age was 9.9±3.6 years, with a predominantly male (72%) population. In 64% of cases, the injury mechanism of BSI was a fall from a height. 26% of patients were hemodynamically unstable. Among the cohort of patients hospitalized since the start of the active use of NOM of BSI, NOM was effective in 94% of patients with low or moderate AAST injury grade, and in 56% of patients with high AAST injury grade. According to the study results, the risk factors that determine the indications for OM in this cohort of patients are BSI of high AAST injury grade (OR 20.0; 95% CI 2.7-53; p<0.01), hemoperitoneum volume >500 ml according to ultrasound and/or CT (OR 15.0; 95% CI 2.3-98; p< 0.01), Hb <92.5 g/l (OR 20.0; 95% CI 1.9-219; p=0.01), hemodynamic instability (OR 5.4; 95% CI 1.4-21; p=0.02).

Conclusion: NOM is an effective treatment for BSI of any AAST injury grade. The decision about OM should be based on haemodynamic instability.

Objective: To estimate advisability of prototypes of ultra-high molecular weight polyethylene (UHMWPE) in hip arthroplasty.

Material and methods: We used 34 UHMWPE specimens for tests and developed a test program consisting of incoming control of specimen geometrical parameters, tribotechnical tests, assessment of liner surface condition and deviation from roundness.

Results: Input control of geometrical parameters of specimens showed their heterogeneity. UHMWPE specimens with negative value (D_c-D_h) failed tribotechnical tests. Specimens with value (D_c-D_h) within 0.6-0.8 mm demonstrated lower value of T moment compared to other specimens.

Conclusion: About 75% of UHMWPE prototype liners are suitable for arthroplasty.

Objective: To analyze treatment outcomes in patients with acute lower limb ischemia.

Material and methods: The results of surgical treatment were analyzed in 779 patients with acute lower limb ischemia. Patients were divided into 3 groups depending on revascularization technique (open, endovascular and hybrid).

Results: There are advantages of hybrid surgery compared to open and endovascular interventions alone.

Conclusion: Hybrid interventions contribute to more complete revascularization of ischemic limbs.

Background: The paper addresses an important section of pediatric combustiology - generalized meningococcal infection, associated with a severe course, the risk of disabling complications, life-threatening conditions, and high mortality.

Objective: The purpose of the study was to share the experience of treating patients with the sequelae of generalized bacterial infection caused by Neisseria meningitidis in a children's burn center.

Material and methods: We conducted a retrospective analysis of the medical records of 23 patients treated in the burn department for babies from 0 to 3 years of the Children's City Clinical Hospital No. 9, named after G.N. Speransky, in the period between 2008 and 2025 for the surgical sequelae of meningococcal disease.

Clinical cases illustrate the late diagnosis of meningococcal infection, the challenges of treating septic shock in the intensive care unit, surgical methods for repairing damaged skin and underlying tissues resulting from generalized meningococcal infection, as well as the indications and timing of organ-resecting surgery. The issues of prevention of this disease in children are considered.

Results: Summarizing treatment outcomes is a challenging task due to the individualized approach to providing specialized medical care during surgical interventions, which varies depending on the severity of each patient's condition, as well as the depth and extent of tissue involvement.

Conclusion: Based on the above, managing such patients requires continuity in treatment following a widely used, unified protocol for local pediatricians, ambulance teams, infectious disease doctors, intensivists, pediatric surgeons, traumatologists, and medical rehabilitation specialists.

Objective: To study the results of treatment of cancer in tubular villous colorectal adenomas.

Material and methods: A retrospective analysis included 51 patients with cancer in tubular villous colorectal adenomas cTis-T1N0M0 between 02.2019 and 09.2021. The median age of patients was 64 (57; 71) years. Minimally invasive interventions were performed in all patients (transanal endoscopic microsurgical resection of the rectum - 25 cases, endoscopic submucosal dissection - 20 cases, laparoscopic resection of the intestine - 6 cases).

Results: Intraoperative complications (intestinal wall perforation) developed in 1 (2%) patient, early postoperative complications (intestinal bleeding from suture line) - in 2 (4%) patients. Throughout the follow-up period (29-84 months), tumor recurrence was detected in 2 (4%) patients with rectal primary tumor, colorectal polyps - in 8 (15.7%) patients. Eleven (21.6%) patients had previous malignant tumors.

Conclusion: The study demonstrated favorable oncological and surgical results of treatment of cancer in tubular villous colorectal adenomas. Minimally invasive interventions are safe and predictable, as well as accompanied by low incidence of complications.

At the solemn meeting of the Russian Surgical Society named after N.I. Pirogov, held on April 29, 1929 in Moscow and dedicated to the 100th anniversary of the birth of the great surgeon-innovator and clinician Professor Christian Albert Theodore Bilroth (Fig. 1), Vladimir Andreyevich Oppel regretfully noted that none of those present in the room will live to see the day when mankind will honor the memory of Theodore Bilroth, the greatest surgeon of the XIX century, on the 100th anniversary of his death. Today, 130 years have already passed (the scientist died in 1894), and we have seen that great deeds and names do survive the ages.

The authors present surgical treatment for giant thoracic aortic aneurysm complicated by aorto-bronchial fistula in a 65-year-old patient. Descending aortic replacement and left-sided pneumonectomy were carried out. Despite the high risks and complexity of intervention, the patient was discharged after 38 days and returned to normal life 3 months later.