The authors present a lecture dedicated to the milestones of modern ideas about anatomy and physiology of upper digestive tract and set forth the key dates of scientific discoveries known to have influenced the evolution of knowledge about gastroesophageal reflux, its aetiology and pathogenetic mechanisms. The paper lays special emphasis on the history of formation of anti-reflux surgery as independent domain of clinical medicine and describes authors’ priorities in developing dedicated lines and methods of surgical treatment for hiatal hernia and reflux syndrome. The authors highlight the Russian researchers’ contribution to the development of theoretical and practical aspects of this problem.

The paper provides a literature overview and analysis of authors’ experience in endoprosthetic replacement on large bowel in case of tumour-induced obstruction. The authors discuss indications and contraindications for stenting, surgical procedure and its complications, modern types of colorectal stents, and describe results of comparison between the colorectal stenting and colostomy, focusing on the results of six implantations of colorectal stents in five patients suffering from tumour-induced obstruction of large bowel.

24 patients with pancreatic pseudocysts have undergone medical treatment at RUDN Intermediate Level Surgery Clinic based at GKB No. 64 (Moscow) from 2006 to 2011. The endoscopic retrograde cholangiopancreatography indicated the cyst was tied to Wirsung’s duct in 75 % of cases that necessitated the endoscopic transpapillar interventions. The endoscopic transgas-tric and transduodenal drainages have been performed, if there were no pseudocysts tied to the pancreatic duct or given the large pseudocysts. There was one post-operative complication, only. The efficiency of applying endoscopic methods has been confirmed by follow-ups lasting from six months to five years. The full regression of cysts occurred in 19 patients. There was one recurrence case.

The paper analyses structure and occurrence of complications based upon 965 endoscopic surgical procedures performed on the digestive tract organs. The bleedings were observed after 0.4 % of polypectomies and 1.1 % of mucosal resections. 0.3 % of polypectomies, 2.2 % of mucosal resections and 10 % of submucosal dissections have been complicated by perforations. There were no lethal outcomes. The occurrence of bleedings and perforations observed by authors has been in the range of indices typical of the endoscopic surgery-related complications described in the foreign literature.

The endoscopic submucosal dissection (ESD) is deemed to be efficient but complex and associated with high risks of complications method intended for removal of large bowel neoplasms. The paper analyses retrospective results of the first 12 ESD of straight intestine and sigmoid colon. 11 neoplasms were removed completely, 1 neoplasm - by fragments. The operations lasted from 20 to 155 minutes. There was one complication - extraperitoneal microperforation treated via non-surgical methods.

The paper provides a retrospective analysis of 30 medical histories of patients with choledocholithiasis and pancreatic b cancer attributed to IV risk group according to the classification of the American Society of Anaesthesiologists. The authors have performed 15 endoscopic interventions under the conditions of total intravenous anaesthesia (propofol, fentanyl, and rocuronium bromide) accompanied by artificial pulmonary ventilation, and 15 endoscopic interventions under the conditions of low flow inhala-tional anaesthesia with controlled respiration (sevoflurane, fentanyl, and rocuronium bromide). Unlike the first group, the second one was characterised by hemodynamic stability during introduction to general anaesthesia with no intraoperative myocardial ischemia. The sevoflurane decreased the need in neuromuscular relaxants and narcotic analgesics.

The paper summarises 12-year experience of performing 265 sessions of endoscopic ligation of varicose veins of oesophagus and stomach to 198 patients suffering from liver cirrhosis, and point out high efficiency of this method to prevent primary bleedings and, combined with sclerotherapy, to prevent recurrent bleedings. In case of ligation procedure, there were early post-operative complications in 2.6 % of cases, and 1.6 % - in case of sclerotherapy procedure. Two patients died because of recurrent bleeding during the follow-up period.

The paper summarises experience of 35 percutaneous paracentetic dilatation tracheostomies performed at the base of endoscopic department of the Vishnevsky Institute of Surgery during 2007-2010 using Ciglia and Griggs methods. There were 4 cases of complications (11.4 %): small bleedings in two patients, tracheostomy wound abscess, and closed injury (fissure) of the 2nd tracheal cartilages. The authors highlight the advantages of low-invasive endoscopic methods over the traditional tracheostomy.

The paper provides results of treatment of 13 patients with benign lesions of extrahepatic bile ducts. The endobiliary stents of various modifications have been implanted into the area of formed coarctations and post-operative defects of bile ducts using an ultrasonic and X-ray image-guided antegrade transseptal approach. The functioning of implants lasted, on average, 18 months, reaching 48 months at maximum. Two patients died as a result of other progressive diseases (lung cancer, liver cirrhosis).

The retrospective non-randomised two-focus examination allowed to compare treatment of 189 patients with malignant upper digestive tract obstruction that included surgical palliative operations (101 patients) or endoscopic prosthetic repair with selfuncrumpled metal stents (88 patients). There were complications in 18.8 and 14.8 % of cases, respectively. The post-operative lethality rates were 27.7 and 6.8 %, respectively. The average length of hospital stay (median duration) reached 21 and 14 days, respectively. The statistic comparison results allows to make a conclusion that the endoscopic prosthetic repair entails comparable number of complications, lower lethality rate that makes it possible to reduce the duration of hospital stay, compared to the traditional surgeries, and can be recommended as final palliative method intended to treat non-operable patients.

Practical application of the endoscopic submucosal dissection known to be more aggressive and radical method than the endoscopic mucosal resection raises a concern about their comparison because these two methods are intended to remove surface epithelial neoplasms. The paper provides results of 99 endoscopic interventions on stomach and duodenum of 92 patients. Unlike the usual mucosal resection, the endoscopic resection with submucosal dissection provides for more occurrence of tumour removal as a single part, but is characterised by longer duration. In case of earlier cancer, the submucosal dissection to a greater extent guarantees complete tumour removal.

A number of modern methods for endoscopic examination of small bowel developed and introduced into the clinical practice at the beginning of the new millennium includes video capsule and balloon-assisted endoscopy for small bowel examination that have made a revolutionary breakthrough in diagnostics and treatment of deep small bowel diseases. The paper opens up ample opportunities in diagnosing and treating small bowel diseases, based on authors’ experience of video capsule (96) and balloon-assisted (169) endoscopies, and discusses procedure of one- and two balloon-assisted endoscopies and their results.

The paper describes results of tracheal stenting for tracheal stenosis in 39 patients aged 18 to 55 years. By its aetiology, the stenosis can be classified as post-traumatic, post-intubation, and tumour one. The authors have performed staged reconstructive operations using intraluminal stents in 23 cases, placed self-uncrumpled devices Hanarostent in 10 cases, and performed primary circular tracheal resection in 6 cases. There were two cases of stent migration. Other complications have not been observed. The stents were removed in 3 to 5 months.

At the VSMU Intermediate Level Surgery, the authors have analysed results of diagnostics and treatment of obstructive jaundice caused by gallstone disease, choledocholithiasis, pancreatoduodenal tumours, and other diseases in 192 patients aged 19 to 93 years. The authors consider that the first stage of treatment and diagnostic measures needed to be undertaken in case of obstructive jaundice should include magnetic resonance cholangiopancreatography; the second one - endoscopic cholangiopancreatography, papillosphincterotomy, endoprosthesis replacement and, according to indications, - percutaneous transhepatic microcholecystostomy; and the third stage - surgery.

The paper describes 39 case follow-ups of submucosal tumours of the digestive tract. The cases of leiomyoma and gastrointestinal stromal tumours have been most often diagnosed in practice. Nine patients were operated via traditional approach, six patients - by laparoscopic one, endoscopic treatment was administered 14 times. The authors believe the mucosal tumours, GIST especially, require applying modern endoscopic methods and obligatory immunohistological analysis of the material at the stage of diagnostics and treatment. In a number of cases, for example, asymptomatic tumours of muscular coat of oesophagus, both non-surgical approach and dynamic observation appear to be methods of choice. The paper highlights the role of endoscopic ultrasonography in determining a number of indications and contraindications to one or another method of surgical treatment.

The paper provides results of research into localisation of nitric oxide synthase in mast cells of mucous coat of 15 sexually mature rats under the conditions of experimental injury of maxillary nerve, and indicates that the lesions in the mucous coat have resulted from deafferentation occurred right after the injury. The mast cells produced nitric oxide synthase and degranulated in the area of the injury. The authors consider that the nitric oxide synthase-inducing mast cells mediate the trophic (protective) and/or toxic effects from the nitric oxide during reconvalescence period after the experimental injury of the maxillary nerve.

The pregnancy induces production of a number of steroid hormones known to be very necessary for foetal development and labour. These hormones are produced due to cholesterol and placenta. The virus-induced lesions found in mother’s organism during gestation period inhibit production of steroid hormones and contents of their source, i.e. cholesterol. The paper describes data that confirm varying cholesterol content in placenta and hormone level in both placental and peripheral blood of 30 pregnant women suffered from herpes-virus infection during gestation period.

The paper provides the study of correlation between heart remodelling indices and mineral density of bone tissue (BMD). The authors have examined 205 women in postmenopausal period, among which 60 women suffered from arterial hypertension and osteoporosis, 43 women suffered from arterial hypertension and normal BMD, 52 women were normotensive with osteoporosis, and 50 women were normotensive with normal BMD. The authors have established the interrelation between BMD and cardiovascular remodelling factors and shown that BMD reduction is a marker of unfavourable concentric variants of heart remodelling, disorder of diastolic ventricular filling by hypertrophic type and increase in “intima-media” complex of carotid arteries.

The authors have carried out case follow-ups of a group of women undergone trocar synthetical sling surgery with ordinary and figured bands (Danilova-Volnyikh method) from 2002 to 2009. The patients were selected via non-invasive urodynamic method of home urofluometry that allowed excluding cases of obstructive disorders. The polypropylene was used as a material for implantation. Levofloxacin was used to conduct pre-operational prevention of infectious complications. There have been no cases of need to remove implant or infectious complications. The case follow-up confirmed high efficiency of this method in recovering the mechanism of urinary continence in all the patients undergone surgery.

At the base of City Clinical Hospital No.68 (Moscow), the authors have studied materials of 167 case follow-ups with respect to obstructive jaundice caused by malignant lesions of the biliopancreatoduodenal area. The radical surgeries have not been performed due to tumour spread and/or severity of associated pathology. The paper compares results of the traditional treatment (application of biliodigestive anastomoses) and minimally invasive surgery with application of self-uncrumpled nitinol stents. As shown, the one-stage endobiliary stenting appears not to be inferior by clinical efficiency to the traditional method of palliative treatment. Besides, the minimally invasive implantation with the self-uncrumpled stents can be used irrespective of the severity of primary disease and manifestation of associated pathology.

The authors have analysed results of treatment of 170 patients aged 18 to 92 years with complicated forms of acute cholecystitis. The endoscopic retrograde cholangiopancreatography, papillosphincterotomy and litoextraction were administered at the first stage to 43 patients with destructive cholecystitis and obstructive jaundice, and to 3 patients with destructive pancreatitis. There was a need to perform percutaneous transhepatic drainage of the bile cyst in 5 cases. All the patients were operated by means of laparoscopy. In 36 cases the surgery showed loose and in 39 cases dense perivesical infiltration. One patient died (0.6 %). The authors make a conclusion about the priority of minimally invasive surgery in case of complicated forms of cholelithiasis and acute cholecystitis.

The paper describes results of research into the geographical features of population’s provision with calcium, magnesium and phosphorus in Primorsky Krai in 2007. The actual average daily doses of consumption of macroelements have been calculated based upon budget observations and questioning with due regard to data about mineral composition of food products and other types of potable water. The authors have revealed insufficient consumption of calcium (22-31.1 % of the consumption rate) and somewhat magnesium (57.4-117.5 % of the consumption rate), as well as imbalance of these elements with phosphorus. As reported, the calcium and magnesium consumption deficit appears to be resulted from decreased consumption of milk and meat products, green vegetables, high-mineralised table waters, ultrafresh tap water and well water. This deficit most often manifests itself in the south-western and north-western parts of the region.

The paper provides first experience of performing single-port laparoscopic surgery. The authors have conducted 14 cholecystectomies and 4 cystectomies by means of S-portal (R. Storz) toolkit. No complications have been observed. The wound was being recovered via primary intention. The authors highlight advantages of single-port laparoscopy and indicate complexities associated with low angle of attack of the tools and their impossibility of rotating.

The paper describes experience in treatment of 70 patients undergone radio-wave excision of gastric polyps. This method allows removing polyps of various sizes and has a number of advantages like minimal blood loss, absence of risk of contact burns, slight necrotic changes of mucous membrane in the area of excision, and prompt epithelisation of the defect. The authors’ experience has made it possible to choose optimum parameters of Surgitron device to be applied to perform endoscopic polypectomy. The long-term results confirm decreasing recurrence rate of polyps occurred on the mucous coat of stomach in the primary removal area.

The authors analyse results of endoscopic prevention of recurrent issues of blood from varicose veins of oesophagus in 37 patients with portal hypertension syndrome. The primary group (17 patients) underwent endoscopic ultrasound-controlled ligation of veins. The control group underwent traditional endoscopic ligation. The authors highlight decreasing recurrence rate of oesophageal issues of blood from 60 to 29.4 % (in control and primary groups, respectively) during the follow-up period lasting up to 18 months.

Based on the results of 134 laparoscopic cholecystectomies performed to women aged 18 to 50 years, the authors discuss features of surgeries performed through three ports mounted in two punctures in front abdominal wall. The small-diameter tools allow achieving almost ideal cosmetic effect and minimising a number of complications. This direction is very promising owing to reasonable combination of a single laparoscopic access method and minilaparoscopy

The paper describes experience of first laparoscopic hernioplasty surgeries with no-fixation implants. The case follow-ups during two months did not reveal any recurrent diseases, causalgia and sensation of extraneous body in the surgical area.

The authors summarise experience of 868 retrograde cholangiopancreatographies performed at the Departmental Clinical Hospital in 2005-2009. The selective cannulation of the common bile duct succeeded in 800 cases (92.2 %). There were 31 cases of complications, including pancreatitis (21 cases), post-surgical lethality (0.5 %). The authors highlight that modern methods with the use of controlled catheters, papillotomes and conductors appear to increase the rate of the selective cannulation and decrease the risk of complications.