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Objective: To analyze the effectiveness of original laparoscopic fundoplication in correction of iron-deficiency anemia (IDA) following chronic blood loss from erosive and ulcerative lesions of esophageal and gastric mucosa in patients diagnosed with hiatal hernia (HH).

Material and methods: A prospective study included 42 patients with verified HH and concomitant IDA who underwent original laparoscopic fundoplication between 2023 and 2024. All patients underwent a comprehensive diagnostic algorithm including extended laboratory testing with assessment of red blood cell parameters and iron metabolism. Treatment efficacy was evaluated after 6 and 12 months through analysis of clinical and laboratory parameters.

Results: Complete regression of gastroesophageal reflux disease was achieved in 39 patients (92.8%). Six-month laboratory monitoring demonstrated normalization of hemoglobin and serum iron levels in 35 out of 37 patients (94.5%). Normal hematological parameters were maintained after 12 months despite the absence of additional iron therapy during the second six-month period. This indicated stable clinical effect of surgical treatment and elimination of primary pathogenetic factor of anemia.

Conclusion: These data confirm high efficacy of surgical HH correction in treating refractory IDA associated with Cameron lesions and emphasize the need for timely detection of this pathology to optimize treatment strategy.

Objective: To evaluate long-term postoperative outcomes in patients with reflux esophagitis, hiatal hernia and concomitant iron deficiency anemia.

Material and methods: The study included 84 patients with hiatal hernia and concomitant iron deficiency anemia who underwent surgery in 2018-2022. All patients underwent original laparoscopic fundoplication. According to age criteria proposed by WHO, patients were divided into two groups. In long-term postoperative period, the authors assessed quality of life, physical and mental health, as well as recurrence rate.

Results: In both groups, the majority of patients demonstrated stable positive results after surgical treatment of GERD. The number of recurrences and QoL impairment did not demonstrate any significant differences in both groups.

Conclusion: The authors obtained comparable results in both groups. This demonstrates safety and high efficiency of original laparoscopic fundoplication in patients of different age groups.

Objective: To analyze the fundamental factors determining the indications for myocardial revascularization in elderly and senile patients; to substantiate the main tactical decisions regarding the choice of conduit and method of CABG in patients with coronary artery disease.

Material and methods: The study included 633 patients who underwent CABG in 2018-2020. According to study objective, two groups of patients were formed: patients < 70 years constituted group A (n=486) and those over this age constituted group B (n=147). Mean age was 63.2±6.6 and 73.7±6.6 years, respectively. The authors analyzed some intraoperative parameters, possible impact of patient characteristics on intraoperative and postoperative period. Safety of surgeries in each group was assessed considering immediate postoperative period, including the incidence of perioperative complications and in-hospital mortality. Survival and quality of life for 5 years after surgery were determined by freedom from adverse cardiac events (MI, stroke, recurrent angina, and recurrent cerebrovascular accident). This part of the study included 41.9% of patients in group A and 42.1% in group B.

Results: We found no significant between-group differences in intraoperative and postoperative parameters, with the exception of duration of mechanical ventilation (MV) after surgery. Ventilation was significantly longer in elderly patients. The incidence of perioperative complications was minor. An exception was atrial fibrillation in 18.3% of elderly patients (more than twice the incidence in younger patients). In-hospital mortality was minimal (one patient in each group). Five-year postoperative survival rate exceeded 95%. CABG provided high quality of life in both groups. Five years after surgery, 82.9% and 75.9% of patients in groups A and B had no clinical manifestations of coronary insufficiency, respectively.

Conclusion: This study demonstrates the importance of a personalized approach to surgical treatment of elderly and senile patients with coronary artery disease. Considering current clinical guidelines for the treatment and choice of myocardial revascularization, it is crucial to consider individual characteristics of elderly patients, including their physical and mental health status, comorbidities and their severity. Appropirate indications for surgery, selection of optimal tactics, and safe method for myocardial revascularization enable effective and long-lasting postoperative results in elderly and senile patients with coronary artery disease.

This review examines the fundamental role of intestinal microbiota in modulating aging processes. According to current data, age-related microbiome changes are not a consequence, but an active mechanism of aging, determining individual developmental trajectory along the path of «successful» or pathological aging. Primary focus is on analysis of cause-and-effect relationship between dysbiosis and systemic aging. Age-related disruption of microbiota (decreased diversity, reduced amount of Bifidobacterium and Akkermansia muciniphila, butyrate deficiency) leads to disruption of intestinal barrier, lipopolysaccharide translocation, and chronic systemic inflammation through TLR4/NF-κB pathway activation. This cascade of pathological processes causes immune senescence and underlies major geriatric syndromes and age-associated diseases. This review provides a detailed analysis of dysbiosis influences on various body systems: neurodegenerative diseases via the gut-brain axis, sarcopenia via suppressed muscle protein synthesis, type 2 diabetes via impairment of insulin resistance, cardiovascular disease via TMAO production, and osteoporosis via impaired bone metabolism. Particular attention is paid to unique microbiota profile in centenarians, where combination of dysbiosis and preservation of specific symbionts (Christensenellaceae, Akkermansia muciniphila) is thought to promote healthy longevity. The article concludes by substantiating potential for therapeutic modification of microbiota as a strategy for correcting the manifestations of aging.

Objective: Linguistic adaptation into Russian language and validation of the Neck impairment index (NII) and Swallowing impairment index (SII) questionnaires.

Material and methods: At the first stage, a procedure of linguistic adaptation of questionnaires into Russian language was carried out. The observational study included 262 patients, of whom 50 were retested after 3 days. The study of internal consistency, test-retest reliability as well as construct and discriminant validity was performed.

Results: A high internal consistency for NII and SII has been observed (a=0.8718 and a=0.8530, respectively). The intraclass correlation coefficient (ICC) indicates an excellent test-retest reliability of both indices (NII -0.9763, SII -0.9900). At the same time, good internal consistency of the scales at both stages of the study has been noted (a NII 0.8528-0.8456; a SII 0.8596-0.8339). The Pearson correlation coefficient between the results of the initial and repeated surveys amounted to 0.9758 for NII and 0.9911 for SII, demonstrating a high degree of data consistency.

Conclusion: As a result of the performed study, the linguistic adaptation of the Neck impairment index (NII) and Swallowing impairment index (SII) questionnaires was carried out. Their validation demonstrated excellent internal consistency, test-retest reliability and clinical accuracy of the Russian version of the questionnaires. These questionnaires can be used for assessing the condition of patients who have undergone neck surgery.

The authors present 2 cases of complex endovascular reconstruction of abdominal aortic bifurcation with good immediate and mid-term results. These examples demonstrate new possibilities in endovascular treatment of occlusive stenotic lesions of terminal abdominal aorta involving common iliac arteries.

Objective: To evaluate the impact of endovenous laser ablation (EVLA) combined with micronized purified flavonoid fraction (MPFF), sulodexide, and their combination on the dynamics of circulating biomarkers and quality of life in patients with varicose vein disease of the lower extremities.

Material and methods: A prospective study included 173 patients who underwent EVLA. They were allocated into four groups: EVLA alone (n=44), EVLA+MPFF (n=43), EVLA+sulodexide (n=43), and EVLA+MPFF+sulodexide (n=43). MPFF was prescribed at 1000 mg/day and sulodexide at 500 LSU/day for two months. Serum levels of E-selectin, MCP-1, VEGF, MMP-2, and MMP-9 were measured using ELISA at baseline (V0), after 2 months (V2), and after 12 months (V3). Quality of life was assessed with validated questionnaires CIVIQ-20 and SF-36.

Results: EVLA alone provided early improvements in quality of life and reductions in E-selectin and MCP-1, although the effect partially diminished by 12 months in patients with advanced disease. MPFF mainly reduced MCP-1 (213.8 → 115.5 pg/mL; p<0.001) and VEGF (109.6 → 52.6 pg/mL; p<0.001), particularly in patients with CEAP C2-C3. Sulodexide significantly decreased MMP-2 (517.8 → 250.8 ng/mL; p<0.001) and MMP-9 (19.4 → 9.9 ng/mL; p<0.001) in CEAP C4-C6, although the effect partly attenuated at 12 months. The most pronounced and sustained effect was observed in the combination group: E-selectin (60.1 → 43.1 ng/mL), MCP-1 (265.4 → 131.3 pg/mL), VEGF (188.7 → 87.1 pg/mL), MMP-2 (487.8 → 230.1 ng/mL), and MMP-9 (19.8 → 8.7 ng/mL) all significantly decreased (all p<0.001), while improvements in CIVIQ-20 and SF-36 were maintained throughout one year.

Conclusion: EVLA provides clinical improvement and reductions in inflammatory biomarkers, but the effect is less durable in advanced disease. MPFF primarily modulates MCP-1 and VEGF, while sulodexide acts on MMP-2 and MMP-9. Their combination shows complementary pathogenetic mechanisms, yielding the most durable biochemical and clinical benefits, and may represent the optimal pharmacological support for EVLA in patients with severe chronic venous disease.

Objective: To improve the outcomes in patients with morbid obesity via prevention of postoperative ventral hernias.

Material and methods. w: E analyzed morphological structure of connective tissue of linea alba in patients with normal BMI and morbid obesity. To confirm safety of synthetic prostheses, we harvested aponeurosis after mesh replacement. Considering insufficiency of connective tissue and safety of synthetic prostheses in patients with morbid obesity, we performed preventive mesh replacement via laparotomy.

Results. p: Reventive mesh replacement in patients with morbid obesity for prevention of postoperative ventral hernias after laparotomy reduced the incidence of this complication from 25.8% to 4%.

Conclusion: The relevance of preventive mesh replacement in patients with morbid obesity is due to frequent postoperative ventral hernias after laparotomy (≥28%). The implanted synthetic prosthesis is characterized by diffuse germination of mature connective tissue as a natural reaction to foreign body. Preventive closure of laparotomy with synthetic prosthesis is advisable in patients with morbid obesity.

The most common thoracoscopic adaptation of box lesion procedure is currently recognized as Dallas lesion set performed with a set of non-irrigated ablation devices. In this procedure, a linear bipolar device is used to create ablation lines on the roof and the floor of the left atrium. Only pulmonary vein collectors are isolated with bipolar ablator clamp. For this reason, effectiveness of Dallas lesion set is lower than thoracoscopic adaptation of box lesion when all ablation lines are formed with ablator clamp (GALAXY procedure performed with irrigated ablator clamp).

Material and methods: A technology of thoracoscopic box-lesion procedure using only one non-irrigated ablator clamp was developed. Twenty-one patients underwent this surgery. At the end of the blind period (90 days), all patients underwent endocardial mapping to study the quality of ablation lines.

Results: There were no surgical complications. Throughout the blind period, 15 (71%) patients maintained stable sinus rhythm, and 6 ones had paroxysms of atrial fibrillation. All 21 patients underwent endocardial mapping at the end of the blind period (90 days). The quality (homogeneity and continuity) of ablation lines, completeness of isolation of pulmonary vein collectors and posterior wall of the left atrium were confirmed in all patients. In 6 patients with paroxysms of atrial fibrillation that persisted throughout blind period, extrapulmonary sources of ectopia outside the isolated zone were detected. We are thought that this was the cause of recurrent arrhythmia.

Conclusion: Original technique of radiofrequency ablation provides complete isolation of pulmonary vein collectors, roof, floor and posterior wall of the left atrium as evidenced by endocardial mapping. Preliminary positive clinical results suggest the follow-up for at least 24 months.

Repeated endovascular interventions and surgical bypass operations for diseases of the lower limb arteries, with progression of the underlying disease, increased stage of chronic ischemia of the lower extremities, and ultimately the development of critical ischemia of the lower extremities, lead to a situation where there are no patent vessels, either native or shunts, through which revascularization procedures can be effectively performed. The way out of this clinical impasse is to develop and actively use new approaches for performing endovascular interventions. Our study presents the currently available "new" approaches and evaluates their safety and effectiveness.