Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

Федеральное государственное бюджетное образовательное учреждение высшего образования «Самарский государственный медицинский университет» Министерства здравоохранения Российской Федерации, ул. Чапаевская, 89, 443099 г. Самара, Российская Федерация Эпителиальная копчиковая киста занимает важное место в колопроктологическом профиле и составляет 15% всех гнойных заболеваний области заднего прохода. Цель ра-боты -анализ результатов хирургического лечения пациентов с эпителиальной копчи-ковой кистой путем закрытия раны непрерывным швом с подхватом дна раны (моди-фицированный метод) в сравнении с иссечением эпителиальной копчиковой кисты и ушиванием раны швами по Мошковичу. Включенные в анализ пациенты (n=82) мето-дом случайной выборки разделены на 2 группы (30 и 52 пациента) соответственно вы-полненному оперативному пособию. Проведен анализ результатов лечения пациентов сравниваемых групп по времени оперативного вмешательства, ранним послеопераци-онным осложнениям, рецидивам заболевания, выраженности болевого синдрома, срокам реабилитации -выявлены различия между группами по развитию ранних послеопера-ционных осложнений (χ 2 =21,72; p=0,05). Таким образом, получены статистически значи-мые данные о преимуществе метода ушивания раны непрерывным швом с подхватом дна раны над методом ушиванием раны швами по Мошковичу.Ключевые слова: эпителиальная копчиковая киста, хирургическое лечение, способ ушивания раны непрерывным швом. ______________________________________________________________________________ COMPARATIVE ANALYSIS OF THE EFFICIENCY OF METHODS OF OPERATIVE INTERVENTION IN PATIENTS WITH PILONIDAL SINUS S.E. Katorkin, L.A. Lichman, P.S. Andreev, O.E. DavidovaSamara State Medical University, Chapaevskaya str., 89, 443099, Samara, Russian Federation Pilonidal sinus is a disease which occupies an important place in Coloproctology profile and constituting 15% of all purulent diseases of the anus. The aim of this work is the analysis of the results of surgical treatment of patients with pilonidal sinus: by closing the wound with a continuous suture with the catch of the bottom of the wound (modified method) in comparison with excision of Pilonidal sinus and suturing wounds seams Moshkovich. All patients (n=82) were divided into 2 groups (30 and 52 patients), respectively completed the operational

Ulcerative colitis (UC) is a common disease with the evident tendency to annual increase in incidence. The disease mostly affects young individuals of active working age. The peak of incidence of the disease is observed at the age of 20-29 and 50-55 years. The aim of study was optimization of diagnostics and management of patients with ulcerative colitis by correction of antibacterial therapy on the basis of the data of microbiological examination of the microflora of the wall of colon. Materials and Methods. 35 Patients with ulcerative colitis from 28 to 61 years of age with the average age 37.6 years who underwent outpatient and stationary treatment in colonoproctology and gastroenterology departments of SamSMU clinics in the period from January to May 2017 were examined. Of them, 18 were males (48.6%) and 17 females (51.4%). Results. Significant species diversity of microflora was identified that requires exact species identification and development of standard procedures for isolation of microorganisms from bioptates of patients with ulcerative colitis with the aim of administration of antibacterial treatment. In analysis of sensitivity of the isolated strains to antibiotics 45% of the isolated microorganisms were found to have signs of resistance to 1-2 groups of medical drugs, and 33% showed signs of resistance to 3 and more groups. Only 22% of strains were found to be sensitive to all tested preparations. Eradication of such flora presents certain difficulties, and in our opinion, requires administration of combined therapy after examination of bioptate. Conclusions. All patients with ulcerative colitis require examination of the microbial composition of the intestinal wall for optimization of diagnostics and treatment. 105-106 titer of microorganisms, their wide species diversity may support inflammation in the colon and prevent relief. It is necessary to continue study of microbiological composition of the colonic wall in the comparative aspect for optimization of diagnostics and management of patients with ulcerative colitis.

Aim. Demonstration of potentials of preoperative planning and implementation of surgical resection in patients with adrenal cysts. A clinical observation of a successful surgical treatment of a rare pathology cyst of the right adrenal is presented. The choice of surgical treatment tactics is determined by the size of tumor and clinical presentation of the disease. The surgical treatment was accomplished laparoscopically which permitted to reduce the time of recovery and rehabilitation of the patient. In this clinical observation, the benefit of using 3D-modeling of the surgical area was shown for visualization of topographic and anatomic peculiarities and facilitation of the intraoperative navigation with the help of Avtoplan program developed by Samara State Medical University. Conclusion. Preoperative 3D-modeling permits to prepare to surgical intervention taking into account individual anatomic peculiarities of a patient, and to determine the optimal volume of the operation.