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The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.

The use of percutaneous drainage of the gallbladder in an acute period can reduce complications and reduce the number of urgent video-laparoscopic cholecystectomies to 1%.

BACKGROUND The activities of the Hospice House established by Count N.P. Sheremetev and opened on June 28, 1810, pursued a noble goal to help the suffering, sick and low-income people. However, this intention alone was not enough, and N.P. Sheremetev took care to really ensure the stable work of the Hospice House, providing for both its publicity and reliable state protection.MATERIAL AND RESEARCH METHODS Annual financial statements of the Hospice Board of Trustees for 1862–1866, 1868, 1871, 1872 and 1902 were introduced into scientific circulation for the first time. To prepare the article, archival material was used, including 6 sources, as well as rare publications dated 1859–1927. Research methods: historical-genetic, comparative-historical, problem-chronological and systemic.RESULTS The analysis of the activities of the Sheremetev hospital for 1810–1909 showed that funds were enlarged regularly with increasing amounts from its budget for the treatment of patients, which number was maximum in 1865 (1,798 people), and the lowest in 1814 (127 people).The personnel of the Sheremetev Hospital took an active part in all major military operations with the participation of Russia (the creation of sanitary detachments to provide assistance to the wounded and sick in combat areas, as well as additional beds located on the territory of the hospital itself).The Sheremetev Hospital played an important role in higher medical education in Russia, becoming the clinical base of the Moscow Medical and Surgical Academy, and later of the Faculty of Medicine of Moscow University; many of its employees were teachers of these educational institutions. The high level of teaching was also ensured by equipping the hospital with modern medical devices and the active introduction of the latest medical achievements into its work.On the initiative of chief doctor A.T. Tarasenkov, a department for incoming patients was organized as an independent structure for the first time in Russia. It provided assistance to 175–200 patients per day. The department became the prototype of a comprehensive outpatient network that was subsequently created in our country.The high prestige of the hospital was brought by the activities of its main doctors and operators, tirelessly working to improve the organizational and medical aspects of the provision of qualified medical care.The final period of the hospital’s activity (1910–1923) until the October Revolution was characterized by the greatest volume of medical work, which subsequently decreased dramatically due to financial difficulties. Since 1919, the hospital functioned as a state institution, and also became the base for the revival of the ambulance service in Moscow.CONCLUSION A review of the activities of the Sheremetev Hospital indicates that the organization of emergency medical care for the population of Moscow, pedagogic work, participation in the treatment of the wounded patients, high surgical activity and versatility were the foundation on which its work was widely developed. It is no coincidence that this particular hospital was reorganized in 1923 into the N.V. Sklifosovsky Institute of Acute Care (since 1944 — N.V. Sklifosovsky Research Institute for Emergency Medicine).Economic difficulties and political storms could not destroy what was created at the Sheremetev hospital and was the moral and material basis for the further 100 years of successful activity of the institute.