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An analysis of early postoperative complications was made in reconstructive surgery on the colon in case of the end colostomy in patients with left-half colon cancer complicated by intestinal obstruction. This work investigated the prognostic factors, which could influence on incidence of complications. The research included results of reconstructive operations in 192 patients. The early postoperative complications were noted in 18 (9,4%) patients. The univariant analysis of risk factors showed, that the presence COPD increased the possibility of complication incidence in 1,7 times (p=0,044). The incidence of purulent complications on previous stage of treatment increased complications in 4,3 times (p=0,011) and the third degree of adhesions process intensity compared with the first degree — in 9,7 times (p=0,001). The multivariant analysis demonstrated a correlation of the complication risks in reconstructive operations with presence of complications on the previous stage of treatment. This correlation was 4,3 (CI 1,7–23,3; p=0,021) and it consisted of 7, 5 (CI 1,3–15,6; p=0,001) in case of presence of the third degree of adhesion process.

A medical trend which is currently gaining strength includes the complex treatment based on the concept of "fast-track" recovery in oncology. An application of modem high-tech approaches allowed minimizing the terms of treatment, shortening economic costs and getting the highest final results. It provides a high quality treatment. Given method could exclude an interim treatment stages, sufficiently reduces terms of general treatment and rehabilitation of patients and could succeed in high quality of life for the patients in short- and long-term period. The authors present the results of successful clinical surgery of 78 patients using this method in public health.

The article discussed the results of surgical treatment of obturative bowel obstruction caused by gallstones. An analysis of results was made in two groups of patients. Ultrasonic tomography and laparoscopic diagnostics were used in the main group. An application of modem methods of diagnostics allowed reducing of lethality rate.

The article presents a retrospective analysis of the results of surgical treatment of postoperative intraabdominal complications in 42 patients with colon cancer complicated by bowel obstruction and perforation of the tumor. The pyoinflammatory processes such as peritonitis and abscesses of abdominal cavity took a leading place in the structure of postoperative complications according to the authors. Method of "closed" decompression and intraluminal irrigation of the large intestine without wide opening of organ lumen was developed and applied into practice as perioperative prophylaxis of pyoinflammatory processes. These measures allowed reducing the rate of postoperative intraabdominal complications from 19.2 to 7.7%.

The article made a comparative assessment of traumatic injury of open hand-assisted laparoscopic anterior resection of the rectum in lateral and spinal positions. The presented technique of hand-assisted laparoscopic colon and rectal surgery is simple. There are advantages in case of obesity presence (IMT more than 30 kg/m2), in significant shortening of the mesocolon and mesentery, high fixation of splenic flexure and intimate fixation of the spleen, in case of bad preparation of the bowels in partial intestinal obstruction or in case of emergency operation, big cancer size, expressed perifocal inflammation. A comparative analysis of dynamics of hormone stress content and metabolism (cortisol, adrenaline, thyrothrophic hormone) showed their expressed increase in blood during operation after traditional surgery. Less stressed reaction was noted after hand-assisted surgery, especially in overweight patients. An application of low invasive method allowed reduction of hemorrhage, pain syndrome, terms of patient's activation and restoration of intestinal motility after operation.

The article estimated the results of excision of temporary loop colo- and ileostomas using method of their formation with erfixation of parietal peritoneum to aponeurosis of abdominal external oblique muscle in 18 patients. The authors concluded that the formation of temporary loop stoma with fixation of parietal peritoneum to aponeurosis had many advantages and could ter mprve he rsuls of the resoraive operation.

Clinical manifestations and diagnostic methods of particular anatomical variants of intestinal rotation and fixation disorders were discussed by the authors in 208 children of different age groups. There was revealed the tendency to reduce rotation abnormalities diversity with the increase of age group. At the same time the frequency of occurrence of the colon fixation anomalies characterized by chronic recurrent process and progressing colostasis was enlarged.

On the basis of an analysis of 2200 cases of left sections colon cancer complicated by obturation intestinal obstruction the authors showed the possibility and reasonability of two-step operation performance. The first operation formed unloading part and the second was the radical operation in one hospitalization. Given method allowed improvement of the results and quality of life of the patients.

The authors studied the clinical characteristics and terms of the development of postoperative intraperitoneal complications in patients undergoing colon cancer surgery. It was stated, that the diversity of clinical data depended on complication characteristics. Results of investigation allowed defining of the most dangerous terms of intraperitoneal complications and risk factors.

At present in medicine and surgery (oncology included) the direction of complex treatment based on the concept of "the fast (accelerated) recovery" (so-called "Fast-Track Recovery" or "Fast-Track Surgery") becomes increasingly popular. It is based on the application of modern hi-tech approaches including effective utilization of basic achievements of VI technology lifestyle of civilization allowing duration of the treatment to become shorter, economic expenses reduced, obtaining possibly definitive results and high quality of treatment. The given approach allows the intermediate stages of treatment to be excluded, general terms of treatment and rehabilitation essentially reduced, higher quality of life obtained at the nearest and remote periods. An example of the successful clinical treatment of 10 patients using the technology in question in practical health service is presented.

In order to improve radicalism of emergency surgical interventions an appropriate method of total mesocolonectomy and D3-lymph node dissection in the medial-lateral direction and the principle of "no-touch technique" were used in 14 patients. This technique is safe, effective, does not prolong the duration of operation and postoperative period, is not followed by increased number of complications and lethality.

A method of intraoperative lavage of the colon was used for the improvement of results of treatment of patients with cancer of the left colon. The method allowed performing one-stage operations and forming primary anastomosis. Incompetence of the anastomosis was noted in one case, no reoperation was needed. Postyopetrative lethality was 3.4%.

The authors propose an individual decision on the character of treatment: strangulated intestinal obstruction should be operated immediately after making the diagnosis; treatment of adhesive intestinal obstruction should be started with conservative methods. Successful treatment, depending on the anamnesis and state of the patient, allows planned total enterolysis or conservative treatment of the peritoneal commissures. If the conservative treatment is not a success, the patients should be operated after normalization of homeostasis, and better in day time. Laparoscopic adhesiolysis in such category of patients is not indicated.

The results of treatment of 120 patients with colonic tumor obstruction, included in the main group, with the formation at the first stage of decompressive double-barrel colostomy were analyzed as well as resection of the colon with ablation of the tumor and simultaneous liquidation of the stoma on the second stage. The overall postoperative lethality was 1.6%. Operations of the second stage were made in 96.7% of the patients. The interval between operations was 18.3 days. The control group consisted of 182 patients with Hartmann operations fulfilled at the first stage and liquidation of the double-barrel colostomy at the second stage. Postoperative lethality was 9.9%. Restorative operation was made in 83.5% of patients. The average term of colostomy was 196.3 days. A comparative assessment of quality of life of the patients fulfilled with the MOS SF-36 questionnaire demonstrated better results in the main group of the patients.

Since 1996till 2008 we have performed 13 864 colodynamic investigations in 3466 patients. In 136 (3.92%) of them a disturbance of the rectoanal reflex was detected and the diagnosis of anal achalasia was made. Dissection of the anal internal sphincter was performed in 93 patients and its efficiency was studied within 1-2, 3-5 and 7-10 years. This intervention was shown to allow recovery of independent emptying in more than 70% of children with anal achalasia.

The authors presented materials on treatment of acute adhesive obstruction in the St. Petersburg Research Institute of Emergency Medicine for 8 years. Operations were performed on 54 patients. A conclusion was made that laparoscopic adhesiolysis had advantages over open surgery methods but with due regard for the selection of patients for the procedure, and for better rehabilitation after operation.

Methods of surgical prophylaxis of postoperative adhesions in the abdominal cavity were developed. On the basis of experimental works in 15 animals the application of the methods of peritonization of portions of the small intestine with a transplant of the autologous visceral peritoneum was well founded. These methods were used in operations on 27 patients aged from 25 to 55 years of age. Observations during the periods from 6 months to 2 years after operation did not reveal signs of recurrent postoperative peritoneal adhesions that were confirmed by instrumental methods of investigation.

An analysis of experimental investigations carried out in 32 dogs and 30 rabbits and laboratory data of 242 patients has shown that the application of antioxidant and antihypoxic medicines decrease reperfusion lesions and endotoxicosis in operative treatment of acute intestinal obstruction.

The authors have analyzed results of the Hartmann operation performed in 119 patients with malignant obturative obstruction of the left half of the colon at hospitals of general profile. A local relapse of cancer was found in 18 (15.1%) of patients, mean time between the primary and restorative operations was 7.4 months. The results of treatment were analyzed in 62 patients in whom the strategy of treatment of malignant colonic obstruction was used with the formation of the decompressive colostomy at the first stage, and radical extraction of the tumor with simultaneous removal of the stoma at the second stage. Lethality was 1.6%. Reoperations were fulfilled in 59 patients within on average 18.4 days after the first one. Early postoperative complications were found in 7 (11.9%) patients. A conclusion was made that such strategy is superior for higher efficacy of treatment and gives better quality of life of the patients.

The authors of the present paper outline the results of studying the use of routine transabdominal sonography and ultrasound irrigoscopy (UI) in the diagnosis of acute colonic obstruction (ACO) in 70 patients. The cause of ACO was tumor-induced colonic luminal obturation in 55 patients and colonic evacuatory dysfunction due to congenital anomalies and acquired constrictions of inflammatory genesis in 15 cases. UI was used to determine the presence, degree, and causes of colonic obstruction. The paper details the UI procedure developed by the authors and the ultrasound semiotics of ACO, shown by routine transabdominal sonography and UI. Analysis of the results of the studies allows the authors to state that UI is as highly informative as X-ray irrigoscopy in the diagnosis of ACO and may be included into a diagnostic algorithm in these patients.

The dynamics of intraperitoneal pressure (IPP) in acute small bowel obstruction was investigated in 50 patients with acute small bowel obstruction (ASBO), 25 men and 25 women aged from 16 through 82 years. The measurements were made in a nasogastral probe. Commissural ASBO was found in 24 (48%) patients, obturation--in 6 (12%), invagination--in 3 (6%) patients. Two groups of patients with high IPP (median 124 mm H2O) and low IPP (median 35 mm H2O) were established. The IPP level over 100 mm H2O, measured at admittance, can be considered an indication to operative treatment. Increased IPP makes the lethality risk of the patient higher. In case of non-complicated course of the postoperative period IPP is not higher than 10 mm H2O by the 2nd day. IPP higher than 30 mm H2O points to the development of intraperitoneal complications.

Results of the complex diagnosis and surgical treatment of 85 patients with acute commissural obstruction of the small bowel have shown that at the present-day stage of the early diagnosis of this disease the method of USI in combination with using metallic "contrast marks" (carried out in 14 patients) holds the leading place. U-shape anastomoses were preferred when making entero-enteral anastomoses and ileoascendoanastomoses which considerably decreased the frequency of incompetent sutures. The developed method of antegrade intubation of the digestive tract was used for correction of syndrome of enteral insufficiency in 46 patients that resulted in a quicker restoration of the small bowel functioning (4-5 days) and correction of the enteral insufficiency syndrome (5-6 days).

The data obtained on 19 children aged 3 months to 14 years with urgent abdominal inflammation (gangrenous appendicitis, perforative Meckel's diverticulum, intestinal obstruction complicated by peritonitis) support suggestion about underlying endotoxin aggression in pathogenesis of disseminated intravascular coagulation.

Neurohumoral changes were studied in 431 patients with acute intestinal obstruction and in experiments in 165 small laboratory animals with the model of small intestine ileus. The results were obtained on the basis of estimation of the concentration of catecholamines, acetylcholine-like substances, serotonine, histamine, their metabolism products in blood plasma and of the cardiointervalography data. The neurohumoral changes were shown to appear as early as the initial stage of the disease and to be progressing when the disease period became longer. The prevailing sympathetic activity was dependent on the decreased acetylcholine-like substances in blood plasma and tissues. The serotonine and histamine metabolism changed depending on the stage of the disease.

Results of 276 laparoscopic operations performed for diagnostic and therapeutic purposes in the early postoperative period in 198 patients are analyzed. All the patients had been previously operated on the organs of the abdominal cavity and retroperitoneal space: in 131 patients the investigations were performed with a diagnostic purpose; in 67 patients a laparoscopic method was used for treatment of complications of the early postoperative period. This problem can be solved by using the methods allowing diagnosing the complication as early as possible, before the development of irreversible alterations, and allowing to choose the most rational methods of treatment.

The work was devoted to problems of treatment of patients with cancer of the colon complicated by tumoral colonic obstruction. The authors propose an improved clinical classification of disturbances of colonic obstruction with colorectal cancer. The questions discussed are: decision on the strategy of treatment of acute colonic obstruction patients, the possible differential approach to choosing methods of treatment depending on localization of tumor and duration of the period of the development of intestinal obstruction. The results of treatment of 148 patients with colorectal cancer complicated by acute colonic obstruction are analyzed. It was shown that in 20% of patients with the initial stage of obstruction with the tumor localized in the left half of the colon it was possible to resolve the obstruction by conservative measures followed by the preparation of the patients to planned operation.

During the period of 2001-2002 in the surgical department of the Republican clinical hospital there were 72 patients with acute small bowel obstruction. In addition to generally accepted methods of diagnosing the acute intestinal obstruction including general rentgenography of organs of the abdominal cavity, radiopaque methods, ultrasound scanning of organs of the abdominal cavity, a measuring-diagnostic system (polygastroenterograph "PGEG-2001") was used which registered and processed fluctuation of biopotentials of different parts of the gastrointestinal tract and measured instantaneous values of the intracavital gastric pressure. So, a short period of time was needed to reliably determine the kind and level of obstruction.

Peculiarities of penetration of living bacterial cultures of Bacillus strain into the structures of the abdominal wall, their positive influence upon the reparative regeneration of surgical wounds were studied in experiments in 240 rats. It was found the living bacterial preparation to be expedient to use as an antagonist of pyogenic infection for purulent postoperative wounds and in order to prevent its development. The clinical antiinflammatory and stimulating the reparative process effects of sporobacterin were studied in 50 patients with infectious wound complications after urgent and scheduled operations. A prophylactic effect was noted in 145 patients operated on for complications of cholelithiasis and commissural ileus. Sporobacterin was proved to give better results of treatment as compared with traditional methods of antiinflammatory therapy with antibiotics.

The authors present results of using temporary shunting of intestinal anastomosis in combination with selective lavage of the suture line with a curative antiseptic mixture in experiment in 12 dogs and in clinic in 36 patients with a probe of the authors' original construction. The probe consists of a polychlorvenyl tube with the inner diameter 0.8-1.0 cm, having two inflatable rubber cuffs mounted on the distal end at a distance of 15 cm from each other. After inflation of the cuffs a closed isolated cavity is formed in the zone of intestinal sutures, into which the distal end of the tube is opened for the decompression and selective intraluminal lavage of the anastomosis. The using of the temporary shunting of intestinal anastomosis in combination with selective intraluminal lavage with a mixture of broad-spectrum antibiotics and antioxidant 1.5% Reamberin accelerates the process of the intestinal suture healing, results in favorable course of the postoperative period, prevents complications.

Intestinal obstruction is diagnosed as one of two kinds--small intestine and large intestine obstruction. They differ in etiology of the obstacle, pathogenesis and degree of clinical picture. The cause of the small intestine obstruction in patients having laparotomy in medical history is the formation of commissures. In patients with intact abdomen the cause of low obstruction was torsion and intussusception, the cause of high obstruction was the obturation with a bile calculus and a foreign body. Causes of the large intestine obstruction were obturation with a tumor and torsion. Napalkov's test is expedient but when suspecting the small intestine obstruction. Conservative treatment is possible in commissural small intestine obstruction (12-24 h) and in large intestine obturation obstruction (not longer than 2h).

The article presents results of experimental substantiation and clinical use of fibrin-collagen plates Tachocomb. They were used in clinical practice in 28 patients with different bleedings under conditions of open and little invasive surgery. The preparation not only increases the mechanical strength of the surgical suture, but also has a stimulating effect on reparative processes. The author proposes to use Tachocomb for strengthening the sutures and anastomoses in peritonitis, intestinal obstruction and interventions in the area of the tissues altered due to infiltration.

The main aim of this paper, by the authors' intention, was to attempt to study and provide evidence for that routine transabdominal sonography has great capacities in diagnosing small intestinal strangulation and obstruction ileus caused by commissures or tumors. The data of 48 cases of small intestinal ileus (27 of its strangulation form and 21 of its obturation one) were analyzed. The paper details guidelines on ultrasonographic techniques and the ultrasound semiotics of this pathology. It is the first time that the authors give individual methodological and semiotic approaches at sonography in this group of papers. They present a particularly clinical picture in combination with ultrasonographic data by providing their constant comparison, which serves as an additional support of the results of this paper. In the authors' opinion, the findings suggest that transabdominal sonography may be a successful basic diagnostic technique for strangulation and obturation forms of small intestinal ileus.

Results of treatment of 68 patients with carcinoma of the right half of the colon complicated by occlusive ileus are presented. The operation of choice is thought to be radical surgical intervention with the primary ablation of the tumor. Palliative operations were performed on 28 (41.2%) of 68 patients with occlusive ileus of the right half of the colon having risk factors, radical operations--on 40 patients (58.8%). Seven patients died at the postoperative period. Over-all lethality was 10.3%.

Results of examination and treatment of 128 operated patients were analyzed. In addition to clinical and roentgenological data the ultrasonic investigation and laparoscopy were also made for diagnosis of commissural ileus. Prevailing was terminal ileus (109 patients). Dissection of the commissures was performed in 115 patients, dissection of the commissures with resection of the intestine was made in 29 patients. Combined operations were fulfilled in 17% of the patients. Sonic stimulation of the intestine was used parallel with medication at the postoperative period which led to earlier restoration of the intestine function. Serious complications were noted in 19 patients, 14 patients died. Main causes of the death were intoxication and peritonitis, hepato-renal and cardio-vascular insufficiency.

Results of surgical treatment of 103 patients are presented who had spread malignant tumors of the female genitalia with the involvement of different segments of the intestine and urinary tract, and damaged intestinal passage. Combined operations were performed on 57 patients (55.3%), palliative--46 patients (44.7%) 54 patients were operated on urgently. For the last 10 years resectability has been increased 8.5 times owing to active surgical policy. Immediate lethality after combined operations was 10.5%. Cumulative indices of 3- and 5-year survival were 66% and 53.3% respectively. Lethality and 5-year survival after palliative operations were 30.4% and 13.8% respectively. Combined operations for cancer of female genitalia (both primary and recurrent ones and metastases) are quite reasonable in order to provide the optimum volume of cytoreduction and perform chemo- and radiation treatment.

For making prognosis of high risk of the lethal outcome the authors used a correlative analysis of 23 factors influencing the treatment results. Ten of them have high correlation coefficients and reliably influence the level of postoperative lethality. The rule of the prognosing of the nearest results of operative treatment is formulated which allows the adequate assessment of the patient's state in dynamics and the timely correction of the process of treatment. The elaborated scheme of the score assessment is simple in use, informative and statistically reliable. It can be recommended for wide clinical practice.

Under analysis were postoperative intraperitoneal complications and results of relaparotomies in 33 patients (13 women and 20 men) aged from 33 to 76 years with obturative ileus caused by stenosing cancer of different portions of the colon. High frequency of peritonitis in the general picture of postoperative complications was due to incompetent sutures of the colonic anastomoses applied during emergency and urgent operations in patients with sub- and decompensated forms of intestinal obstruction. The best variant of completion of radical operations in emergency surgery in this category of patients is the formation of a single- or double-trunk colostomy without a primary reestablishment of the continuity of the intestinal tube especially when stenosing cancer is localized in the left part of the colon.