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All adenomas of the major duodenal papilla (MDP) require resection regardless of morphological structure due to high risk of malignancy. Currently, intraluminal endoscopic interventions are preferable for these adenomas. MDP neoplasms with intraductal spread (type III and IV) are of particular difficulty for endoscopic techniques. Intraductal radiofrequency ablation provides new opportunities for minimally invasive treatment of patients with MDP adenomas and intraductal component. A 72-year-old patient after previous endoscopic papillectomy for MDP adenoma admitted to the Vishnevsky National Research Medical Center of Surgery due to residual adenomatous growths within the papillectomy zone extending to the common bile duct throughout 13 mm. The patient underwent intraductal RFA under endosonography and cholangioscopy. Despite difficult localization of residual growths extending to the common bile duct, endosonography-guided intraductal RFA provided total destruction of residual tumor that was confirmed by cholangioscopy. Length of treatment was 4 months, relapse-free period - 10 months. Minimally invasive endoscopic technology for residual MDP adenoma provided good clinical results.

The article includes a clinical case of a patient with deep infiltrating endometriosis with rectum involving and using intraoperative controlled fluorescence in order to increase the radicality of surgery and improve the prognosis of the disease. Surgical excision of the endometrioitic nodules is the only effective way of treating patients with colorectal endometriosis in terms of relieving pain, improving quality of life and restoring reproductive function. The possible types of surgical interventions can be performed: endometrioid lesion shaving, discoid or circular intestinal resection with anastomosis. The extent of the operation is determined by the following morphological parameters: the number of endometrioid infiltrates of the intestinal wall, the size of each of them, the degree of involvement of the intestine circumference, the depth of the intestinal wall lesion, the distance from the level of anus to the endometriotic nodule and lymphatic dissemination.

Objective: To prove from a clinical and economic point of view the expediency of using ICG cholangiography in patients with «difficult» laparoscopic cholecystectomy for the prevention of damage to the bile ducts.

Material and methods: The results of treatment of 173 patients with cholelithiasis at various levels of health care providing were analyzed with regard to assessment of indicators of surgery complexity, developed complications and economic costs.

Results: The effectiveness of the original scale of «difficult» laparoscopic cholecystectomy has been proved. The financial and economic costs of treatment of patients with damage of biliary ducts and patients with cholelithiasis without development of complications have been analyzed and evaluated. A comparative description of financial costs for patients with «difficult» laparoscopic cholecystectomy with the use of ICG-cholangiography has been given. A program on care delivery for patients suffering from cholelithiasis in the conditions of region with regard to safety and economic effectiveness has been developed.

Conclusion: The implementation of this program provides the minimization of postoperative complications and fatality at all levels of surgical care delivery. It has been established that a rational approach to reducing the number of biliary ducts damages is their prevention by prediction of «difficult» laparoscopic cholecystectomy and performance of such interventions in medical organizations of III level with the possibility of modern technologies use.

Methodological recommendations for surgical care in patients with hemophilia A receiving prophylactic therapy with emicizumab. Recommendations of the expert group. Moscow, 2024.

Objective: To present treatment of primary esophageal melanoma in a young patient, as well as review of modern data on this issue.

Material and methods: We describe the results of treatment of a patient with primary melanoma of the esophagus. PubMed, SCOPUS, and elibrary databases were used for the review.

Results: We present a rare case of primary esophageal melanoma and variant of radical surgical treatment. The review is devoted to historical information about this nosology, statistical data, options for diagnosis and treatment.

Conclusion: Such a rare clinical case is of great scientific interest due to the rarity of this disease. In our opinion, a certain register of orphan malignant tumors is necessary for diagnosis and treatment of various rare malignancies.

Objective: To study the changes in indicators of oxidative toxemia, hypoxia and intra-abdominal hypertension in various forms of acute pancreatitis.

Material and methods: The results of complex diagnostics in 62 patients with various forms of acute pancreatitis were analyzed. We estimated the indicators of oxidative status, hypoxia and intra-abdominal hypertension. Edematous pancreatitis was diagnosed in 35 (56.5%) patients, destructive acute pancreatitis - in 27 (43.5%) patients (sterile pancreatic necrosis in 14 (22.6%) patients, and infected pancreatic necrosis in 13 (20.9%) patients).

Results: Progression of disease is followed by active lipid peroxidation with accumulation of conjugated dienes and malondialdehyde, as well as increase in serum lactate and pyruvate levels. Intra-abdominal pressure increases with progression of disease and destructive processes. There was direct correlation between intra-abdominal pressure and clinical form of acute pancreatitis (r=0.8033, p<0.001). The same was true for intra-abdominal pressure and indicators of oxidative toxemia (conjugated dienes - p<0.001, malondialdehyde - p<0.001) and hypoxia (lactate - p<0.001, pyruvate - p<0.001, and hypoxia coefficient - p<0.001).

Conclusion: A comprehensive examination of patients with acute pancreatitis allows to analyze lipid peroxidation, hypoxia and intra-abdominal hypertension. These parameters depend on clinical form of disease.

Acute appendicitis in adults. Clinical guidelines.

A rare case of thyroid foreign body is presented. The swallowed fish bone perforated the pharyngeal wall and migrated to the thyroid gland. The rarity of pathology caused diagnostic difficulties. Despite the correct diagnosis, wait-and-see tactics was initially chosen that delayed surgery and contributed to tissue inflammation. The stages of therapeutic and diagnostic process are analyzed. Endoscopy is not always effective, especially when foreign body migrates from pharyngeal lumen into soft tissues. Ultrasound and CT are necessary for topical diagnosis of migrated foreign body. These methods revealed fish bone migration towards cervical vascular bundle and local complications. Literature data and own experience are analyzed. Early surgical treatment guarantees good results and rapid rehabilitation.

Comment on the article "Successful treatment of severe purulent peritonitis against the background of intra-abdominal hypertension syndrome".

Objective: To develop the adapted scale for analysis of necessary septal myectomy (SME) in aortic valve replacement (AVR) for severe aortic stenosis.

Material and methods: A retrospective and prospective analysis included 180 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm who underwent surgery between 2012 and 2024. Age of patients was 64 (61; 67.3) years. There were 96 (53.3%) men and 84 (46.7%) women. Heart failure NYHA class III was observed in 98 patients (54.4%), class II in 54 (30.0%) patients. The AVR+SME group included 100 patients, and the AVR group included 80 patients. Both groups did not differ in preoperative clinical and echocardiography characteristics.

Results: Logistic regression was performed to identify significant predictors. Multivariate analysis provided logistic function including 3 predictors: IVST / PWT, indexed LV myocardial mass and aortic annulus diameter. Regression model included significant factors obtained at the first stage of analysis. The obtained prognostic model was significant (p<0.01). Sensitivity was 77.0%, specificity - 83.8%. IVST/ PWT and indexed LV myocardial mass increase the probability of concomitant SME, while aortic annulus diameter has inverse relationship. The cut-off point for indexed LV myocardial mass is 167.5 g, for IVST/ PWT - 1.15, for aortic annulus diameter - 23.5 mm. Further analysis was performed by assigning a score to each predictor. The total score in two groups was determined. Thus, total score > 83.5 indicates advisability of SME in aortic valve replacement.

Conclusion: The new scale for predicting the need for SME in AVR will improve postoperative results.