IntroductionPerforation is a dangerous complication of peptic ulcer disease and requires emergency surgical treatment. In recent decades laparoscopic repair of duodenal perforation has been widely used in emergency abdominal surgery.AimTo analyze laparoscopic and open surgical treatment of 120 consecutive patients with perforated duodenal ulcer.Material and methodsThe study included a group of 120 consecutive patients, operated on for perforated duodenal ulcer in a single institution. Laparoscopic or open repair with or without an omental patch was performed. The value of the Boey score was investigated in predicting the outcomes of treatment in the entire study group.ResultsIn 61 (50.8%) cases open repair was performed, in 56 (46.7%) cases laparoscopic repair, and in 3 (2.5%) cases conversion was performed. In the laparoscopy group the mean hospital stay was 5 days (range: 3–14), in the open group 11.7 days (range: 6–63), and in the conversion group 9.3 days (8–10) (p < 0.001). There was a significant difference between characteristics of patients in the laparoscopic groups: in the second period of laparoscopic procedures (2014–2017) the duration of the operation was significantly shorter and the number of postoperative complications was significantly lower than in the initial study group (2010–2013).ConclusionsThe laparoscopic approach is an effective method for treatment of perforated duodenal ulcer in selected cases. A number of 20–25 cases for the surgeon operating with the laparoscopic method is sufficient to achieve an acceptable level of expertise. More prospective randomized studies are needed to evaluate the effectiveness of laparoscopic repair of perforated duodenal ulcer.

25 Актуальность проблемыСпаечная болезнь живота -причина повтор -ных операций, осложнений внутрибрюшных вме-шательств, порой инвалидности пациентов -остается сложнейшей, актуальной проблемой хи-рургии. Лапаротомия приводит к образованию спаек в 95-100% случаев и спаечной тонкокишеч-ной непроходимости (СТКН) в 3% случаев [1,2]. Mорфологически невыраженные и клинически асимптоматичные спайки обычно не представля-ют угрозы, но в 5% случаев после внутрибрюшных операций спайки приводят к повторной госпитали-зиции по поводу кишечной непроходимости, абдо-минальных и тазовых болей, бесплодия у женщин [2]. Каждое лапаротомическое вмешательство по поводу кишечной непроходимости приводит к об-разованию новых, более распространенных спаек, что повышает риск возникновения непроходимо-сти. Рецидив СТКН является большой проблемой для хирургии [3].Проблема имеет также большое социально-эко-номическое значение. Например, в США общие за-траты на лечение спаечной болезни живота состав-ляют ежегодно 2 млрд долларов [4,5]. В Швеции тратят в год 13 млн долларов США на уход за боль-ными, страдающими спаечной болезнью живота [4].Хирургический адгезиолизис -пока един-ственный метод лечения уже сформированных спаек брюшной полости, но ни один способ адге-зиолизиса не решает проблему повторного спай-кообразования. В этом вопросе пока единствен-ным общепринятым выходом остается применение противоспаечных средств [1,2]. Были предложены противоспаечные барьерные средства для местного применения и препараты общего воздействия, од-нако немногие из них нашли клиническое примене-

Studies have found that regardless of the place of residence, with an increase in the severity and intensity of the labor process in obese medical workers there is a marked decrease in the quality of life. The working conditions have an impact on the growth of morbidity in obese doctors.

Objective: The aim of the study was to analyze the structure and dynamics of morbidity of athletes, members of sports teams of the city of Moscow based on the results of an in-depth medical examination in the period 2017–2021.Materials and methods: The data of the medical examination of athletes, which took place at the Moscow scientific and Practical Center for Medical Rehabilitation, restorative and sports medicine, including instrumental, functional and laboratory studies from 2017 to 2021, were analyzed. In 2017, 15176 athletes were examined, in 2018 and 2019, 11200, in 2020, 10080 people and in 2021–11922 athletes.Results: The results of the study showed an increase in the proportion of amenorrhea within the triad of athletes, an increase in general therapeutic morbidity, diseases of the gastrointestinal tract, among which the proportion of secondary hyperbilirubinemia in 2021 increased 3 times compared to 2020, which, in our opinion, is also due to the impact of the pandemic and quarantine restrictions.The high prevalence of ophthalmological morbidity of athletes and changes in the cardiovascular system is shown. During 2017–2021, a change in the structure of cardiac morbidity was revealed in the form of an increase in the proportion of cardiac arrhythmias and hypertensive response to stress.An increase in the endocrine morbidity of athletes in 2021 was revealed due to an increase in the proportion of hypothyroidism and more frequent detection of hyperthyroidism, possibly related to the COVID-19 pandemic, which requires further research.There was also an increase in diseases of the skin and genitourinary system in athletes. Psychological problems of athletes increased during the observation period from 2017 to 2021. There was no significant dynamics of surgical and traumatological diseases, otolaryngological pathologу.Conclusion: The results of the study indicate the importance of regular full-fledged examination of athletes, identification of various functional disorders and diseases for their timely prevention and treatment in order to preserve the health of athletes and improve athletic performance.

No abstract