The luminal intestinal microflora affects the state of the muscular system of experimental animals and humans. The role of nutrition in the development of skeletal muscles is considered. The role of metabolically active substances secreted by the microbiota in the development of cachexia, sarcopenia, and kwashiorkor is considered. The effect of exercise on the gut microbiome was assessed. Possible variants of the influence of probiotics on the state of skeletal muscles and its functional activity in the experiment in animals and humans are presented.

The article analyzes the world experience in methods of applying of stomach nutritional fistula. Different methods of gastrostomy are described, their classification is given. The advantages and disadvantages of common surgeries are outlined. The most often used traditional surgeries are: gastrostomy by Stamm, Topver and tubular gastrostomy. Complication rate of these operations led to a further search for minimally invasive techniques: percutaneous puncture, laparoscopic gastrostomy, and laparoscopically- assisted percutaneous endoscopic gastrostomy. A significant disadvantage of minimally invasive puncture techniques is the need to purchase relatively expensive disposable sets for primary installation and replaceable low profile tubes. The cost of these supplies in Russia is much higher than the money allocated in the obligate medical insurance system, which makes the method economically unprofitable for medical institutions and patients. Partially, the costs could be reduced by the use, as a gastrostomy tube, a Foley urinary catheter. There are several studies that have confirmed economic advantages and absence of a reliable difference in the number of complications and duration of use such tubes. However, some complications are reported: migration of catheter into the duodenum with the development of obstruction, decreased comfort and quality of life. The conducted study showed absence of classification of gastrostomy types and their complications. The final consensus in clinical use of different types of gastrostomy in different situations is absent. There is a tendency to decrease rate of traditional laparotomical operations in favor of less invasive interventions making it difficult for adequate analyzing. In cases with need for revision, biopsy and fundoplication, laparoscopic or laparoscopically-assisted percutaneous endoscopic gastrostomies are preferred which has proven itself in children. For a group of palliative patients of elderly age with high risk and doubtful prognosis, minimally invasive puncture gastrostomes are more appropriate.

Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation.

Sarcopenia is a condition of progressive loss of muscle mass, moststudied in patients of senile age. Sarcopenia is described in children with oncological diseases, severe surgical pathology, in  the perioperative period with liver transplantation, immobility in children with cerebral palsy. Sarcopenia is associated with adverse disease outcomes. This article discusses the problem of sarcopenia using the  example of patients with stable dysmotility and posture. In addition to limited mobility, among the causes of  sarcopenia are impairment of the ability to eat, the availability of basic nutrients and vitamin D, and a change in the intestinal microbiome. Nutritional support combined with physical rehabilitation has been shown to be effective in reversing sarcopenia.

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