Parahiatal hernias are the rare variant of a diaphragmatic hernias. They are characterized by the formation of the neck of the hernia sac laterally to the diaphragm crura (usually the left), which distinguishes them from hiatal hernias. Hernia usually affects the fundus and body of the stomach, the esophagogastric junction remains below the level of the diaphragm, and clinical manifestations are associated with episodes of strangulation or axial volvulus. The article describes a case of parahiatal hernia complicated by chronic gastric volvulus with subsequent development of acute axial volvulus, which required urgent laparoscopic management.

Acute intestinal obstruction is a multifactorial disease. Its causes may be intra-abdominal adhesions, volvulus, bezoar, gallstones, foreign bodies, intestinal tumors, etc. In rare cases, acute intestinal obstruction may be associated with intussusception, which is relatively rare in adults. The purpose of this work is to demonstrate a clinical case of acute small bowel obstruction caused by Burkitt lymphoma. During treatment for a herpetic infection, the patient underwent surgical treatment — ileostomy because of acute intestinal obstruction. In the postoperative period, the patient was hospitalized due to intestinal bleeding; during diagnostic colonoscopy, intussusception of the ileum into the ascending colon was detected; diagnostic laparoscopy, laparotomy, right-sided hemicolectomy with resection of the greater omentum, restoration of intestinal continuity with elimination of the stoma, and formation of an anastomosis were performed. The material obtained intraoperatively was sent for pathomorphological examination, including the method of fluorescent hybridization, which revealed a rearrangement of the 8th chromosome in the region of localization of the MYC gene in tumor cells, and a diagnosis of Burkitt lymphoma was established. The oncological council determined the chemotherapy treatment protocol. According to the literature, Burkitt lymphoma can debut in the cutaneous form, and it is necessary to carry out a differential diagnosis, including chickenpox. There is currently no information about intestinal complications occurring in the cutaneous form of Burkitt lymphoma. It is possible that in the described case, the initially established diagnosis of herpetic infection was incorrect, and Burkitt lymphoma occurred in the cutaneous form.

The purpose of the study was to create an index based on the total results of special research methods that characterizes the antireflux function of the cardia in the long term after its video-laparoscopic correction in GERD patients with hiatal hernia (HH). Long-term results of video-laparoscopic antireflux intervention in 213 patients with GERD and HH were analyzed. Based on the results of a remote survey and instrumental examination, the patients were divided into three groups. The first group consisted of the patients who had symptoms of GERD, but the presence of pathological gastroesophageal reflux was not confirmed by instrumental methods (122 patients, 57.3 %); the second group included the patients with recurrent GERD (19 patients, 8.9 %); the third group (72 patients, 33.8 %) consisted of the patients without GERD symptoms or its recurrence. To assess the antireflux function of the cardia in the long term after its video-laparoscopic correction, the index of failure of the antireflux function of the cardia (IFAFC) was developed based on the generalized results of instrumental research methods. Before surgery in all groups of the patients, the IFAFC did not have a statistically significant difference and indicated a very significant severity of signs of failure of the antireflux function of the cardia (0.70±0.06, 0.74±0.05, and 0.70±0.06, respectively; р>0.05). In the long term after surgery, the patients with false-positive GERD symptoms showed an improvement in the IFAFC by 87.14 % (p<0.001), the patients without symptoms of GERD and its recurrence — by 92.86 % (p<0.001), and the patients with recurrent GERD — by 16.22 % (p<0.05). The IFAFC allows assessing the results of the antireflux surgery. In the absence of recurrent GERD, the IFAFC is 0.05±0.01; in patients with recurrent GERD, it is 0.62±0.07. The IFAFC equal to 0.09±0.07 is typical for patients at risk with false-positive symptoms of GERD without confirmation of its relapse by special studies. These patients require follow-up.

40 patients with grade 2 and 3 rectocele were included in the study. The long-term results of surgical treatment within a timeframe of 12–42 months after surgery were evaluated in 34 (85 %) patients. The average duration of the disease history amounted to 5 (0.7–19) years. The mean age of the patients was 53.1±10.3 (Me=54.5) years. Before the surgery, as well as 6 and 12 months after the surgery, all patients underwent radiological defecography and were interviewed by means of specialized questionnaires to determine the disorders of the evacuation function of the colon and comprehensively assess the symptomatology of pelvic organ prolapse. Late postoperative complications were revealed in 2 out of 35 (5.7 %) patients 6 months after the surgical intervention. Twelve months after surgery and over, 31 out of 34 (91 %) patients had good or satisfactory outcomes characterized by a significant decrease in the manifestations of obstructed defecation syndrome, confirmed by the results of defecography, which showed an improvement in all criteria of the rectal evacuation function evaluation. These data objectively confirm the effectiveness of this method of treatment. The comparative analysis of the results of the patient survey by means of specialized questionnaires demonstrated a statistically significant difference between the level of scores before the intervention and 12 months after rectovaginal septum repair with W-shaped mesh implant. In conclusion, the method of rectovaginal septum repair with W-shaped mesh implant demonstrated its high efficiency, including the evaluation in the long-term follow-up period.

The purpose of the study: to identify risk factors for decreased quality of life in patients with permanent colostomy. The results of a survey of 114 patients with permanent stoma after radical surgical treatment of stage I–III rectal cancer were analyzed. The quality of life was assessed with EORTC QLQ-C30 questionnaire. Severe impact on the global health status (less than 50 points) was observed in 21 (18.4 %) respondents. The significant risk factors of impaired quality of life include the absence of preoperative stoma site marking (OR = 6.5, 95 %CI = 2.0–20.4; p = 0.002) and the lack of specialized stoma care service in the region of residence (OR = 4.6, 95 %CI = 1.6–13.1; p = 0.005). The emergency nature of the primary operation also had a significant negative impact on subsequent quality of life (OR = 6.1, 95 %CI = 1.8–20.1; p = 0.004). The employment had a positive effect on the quality of life of patients (OR = 0.2, 95 %CI = 0.07–0.9; p = 0.024). Conclusion. The quality of life of patients with a permanent colostomy after radical surgery for rectal cancer depends on several factors. The absence of preoperative stoma site marking, inaccessibility of the rehabilitation service for colostomy patients in the region, and surgery emergency negatively affect the quality of life of this category of patients.

One of the features of the special military operation is the prevalence of fragment wounds with predominant damage to unprotected parts of the body. Wounds and injuries to the neck constitute no more than 4 %; however, with these injuries, irreversible losses amount to up to 13 %. The article describes a clinical case of a patient with a blind gunshot fragment wound to the neck, who was admitted to the surgical (thoracic) department of the 1469 Naval Clinical Hospital of the Russian Ministry of Defense 21 days later. The fragment, located behind the pharyngoesophageal junction in the projection of Killian's triangle, led to the development of an abscess and threatened perforation of the esophagus with subsequent development of mediastinitis. In addition, the article on surgical tactics justifies the access and describes in detail the technical methods of surgical intervention.