Aim. Evaluate the advantages and disadvantages of laparoscopic and robot-assisted anti-reflux operations.General findings. Reflux esophagitis in the association with hiatal hernia on the third place in the structure of gastroenterological diseases. The development of minimally invasive surgical technologies has led to an increase in the number of laparoscopic and robot-assisted anti-reflux operations. The literature review includes 12 studies, the results of which were published from 2002 to 2020, with a total number of patients 1633. In most of them, when comparing laparoscopic and robot-assisted anti-reflux operations, the advantages of one or another technique were not revealed. In some studies, the high cost and duration of the operation were noted when using the da Vinci robotic surgical complex. Other studies have reported possible improvements in the treatment outcomes of patients with large or recurrent hiatal hernias due to the high precision of movement and improved visualization characteristic of therobot-assisted surgeries.Conclusion. It is necessary to conduct more researches on this problem to develop indications for the choice of a particular surgical approach, as well as to create a single transparent algorithm for the surgical treatment of patients with reflux esophagitis and hiatal hernia.

The importance of a multidisciplinary approach in the surgical treatment of patients with severe combined oncological and cardiovascular pathologies is shown. In modern surgery, there is a place for both simultaneous and staged surgical treatment of this category of patients, which should be determined in each specific clinical case and requires an individual multidisciplinary approach with the inclusion in the discussion of such specialists as an oncosurgeon, a chemotherapist, a radiation therapist, a cardiologist/therapist, cardiovascular surgeon, anesthesiologist and resuscitator. Two clinical cases of a two-stage and one-stage surgical approach in the treatment of patients with competing gastric cancer and coronary heart disease are presented. One 47-year-old patient underwent two-stage surgical treatment: stage 1 aortocoronary bypass grafting from mini-thoracotomy (MICS CABG); stage 2 robot-assisted distal subtotal resection of the stomach (Balfour modification) with D2 lymphadenectomy, formation of intracorporeal gastroenteroanastomosis and interintestinal anastomosis according to Brown. Another 74-year-old patient underwent a one-stage surgical intervention: autovenous coronary artery bypass grafting of the anterior interventricular artery, posterior descending coronary artery on a beating heart, without cardiopulmonary bypass + extended-combined gastrectomy with resection of the distal esophagus, resection of the diaphragm, and D2+ lymphadenectomy. The postoperative period proceeded without complications.

Aim. To compare the long-term outcomes and qualitive of life (QOL) of robot-assisted fundoplication (RAF) and laparoscopic fundoplication (LF) in patients with cardiofundal and subtotal hiatal hernias (HH). Materials and methods. The study included 62 patients with HH, who underwent antireflux surgery in the clinic of Faculty Surgery No. 1 of Sechenov University in the period from January 2015 to February 2021. The main group included 32 patients who underwent robot-assisted fundoplication (RAF) according to A. F. Chernousov, the comparison group included 30 patients who underwent laparoscopic fundoplication (LF). Complaints of the patient, X-ray, endoscopic studies, PH-impedance-metry in the long-term period were evaluated. To assess the quality of life, the questionnaires SF 36 (The Short Form-36) and GERD-HRQL (Health-Related Quality of Life in Patients with Gastroesophageal Reflex Disease) were used. Results. Periodic heartburn in the long-term period was noted by 2 (6%) patients of the RAF group and 4 (13%) in the LF group. Endoscopic signs of mild esophagitis were detected in 1 (3%) patient from each group. X-ray in 9 (28%) patients of the RAF group and 11 (37%) patients of the LF group showed migration of the esophageal-gastric junction above the diaphragm level with complete preservation of the antireflux function of the fundoplication cuff. The QOL indicators of the SF 36 questionnaire did not differ in both groups and were comparable to the population of “conditionally healthy” people. The indicators of the GERD-HRQL questionnaire were better in the RAF group, but the differences had no statistical significance (RAF - 2.53 ± 5.1 points versus LF - 5.23 ± 9.4 points, p-value = 0.321). Conclusion. RAF and LF in the modification of A. F. Chernousov are equally effective in the treatment of RE and GPOD in the long-term period and provide good indicators of quality of life that do not differ statistically from each other.

The study on gastrointestinal tract reconstruction after proximal gastrectomy (PG) for stomach cancer aimed to identify the most optimal way to restore the integrity of the gastrointestinal tract. The study involved a comparative analysis of 23 papers with a total of 1,517 cases of reconstructions after PG from four countries during the period 2010—2021. The five most commonly described types of reconstruction after PG were analyzed: jejunal interposition, esophagogastric anastomosis, ‘double tract' reconstruction, ‘double flap' reconstruction, and jejunal pouch interposition. The comparison criteria included the duration of surgeries, intraoperative blood loss, length of hospital stay, as well as postoperative complications such as anastomotic leakage, anastomotic stricture, reflux esophagitis, and residual food. The results of the study can provide valuable insights for surgeons in choosing the most optimal type of reconstruction after PG, thus reducing the risk of postoperative complications and improving the quality of life of patients with stomach cancer.

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