At present, endoscopic haemostasis is the main method to arrest bleeding and to prevent its recurrence in patients with gastroduodenal ulcer bleeding, but there is still no consensus on the superiority of one or another method of endoscopic haemostasis. Now, according to many specialists, the recurrence of ulcer bleeding is no longer an absolute indication for surgical treatment, especially in individuals with severe somatic diseases, but serves as an indication for repeated endoscopic haemostasis. The purpose of the study was to compare the effectiveness of different methods of endoscopic haemostasis in the prevention of ulcer bleeding recurrence, as well as to study the feasibility of repeated endoscopic haemostasis in case of bleeding recurrence. The study is based on the analysis of the treatment of 268 patients with gastrointestinal bleeding who were urgently admitted to surgical departments. Primary endoscopic haemostasis was performed in 142 (52.9%) cases: argon plasma coagulation was used in 56 (39.5%) observations, the injection method was used in 47 (33%) observations, and their combination was used in 39 (27.5%) observations. According to the research data, the majority of recurrences, 34 (51.5%) cases, occurred within the first day following the admission to the hospital. The study of the probability of bleeding recurrence depending on the initial intensity (Forrest) determined that the frequency of the recurrence is statistically higher in class I-A and I-B than in II-A and II-B. Out of 66 patients with recurrent bleeding, repeated haemostasis was found to be effective in 51 (77.3%). At the same time, the efficiency of the injection method made up 60%, argon plasma coagulation was found as more effective (81.4%), and the combined approach demonstrated the highest efficacy of 94.7%. According to the results, we can suggest that in case of bleeding recurrence, repeated endoscopic haemostasis is a quite adequate alternative to the surgical treatment, especially in patients with severe somatic diseases. The use of endoscopic repeated haemostasis in case of recurrent bleeding can reliably reduce the mortality rate from 28 to 13.6%.

We conducted a retrospective and prospective analysis of the examination and treatment of 89 patients with cancer of the hepato-pancreato-duodenal zone complicated by mechanical jaundice. Cancer of the head of the pancreas was found in 69 patients, cancer of the major duodenal papilla was detected in 10 patients, cancer of the extrahepatic bile ducts – in 9 patients, and cancer of the duodenum – in 1 case. All patients were divided into 3 groups depending on the degree of jaundice. Operative treatment was performed in 86 patients. Of them, 13 were operated on at the height of jaundice, and 73 – after previous minimally invasive decompression of the biliary system. Postoperative complications were observed in 17 (19.1%) patients, 12 (16.4%) of whom were operated on at the height of jaundice, and 5 (6.8%) – after previous biliary decompression (second-stage operations). In 6 patients with severe jaundice who were operated on at the height of jaundice, complications occurred even after minor palliative operations. Thus, in the presence of severe jaundice with bilirubin level > 200 μmol/l, radical and palliative operations should be performed only in two stages, after preliminary decompression of the bile ducts. Decompression of the bile ducts allows the reduction of the preoperative period by 2–3 weeks.

The coronavirus disease (COVID-19) has entered our lives since 2019. This severe respiratory disease is caused by type 2 coronavirus (SARS-CoV-2). Since its first appearance in December 2019, it has led to a worldwide pandemic that continues to this day. Kidneys can be one of the target organs when infected with coronavirus type 2 (SARS-COV-2). It is necessary to pay attention to surgical interventions on the urinary system against the background of COVID-19. In light of the COVID-19 pandemic, special attention should be given to surgical interventions involving the urinary system. While various methods of correction for purulent-septic and obstructive urological diseases have been proposed for numerous conditions, specific indications and contraindications for patients with coronavirus infection remain largely unexplored. The purpose of the study is to analyze the impact of the incidence of COVID-19 on the prevalence and severity of acute urological pathology, to determine the frequency and distribution of complications. The study is based on the analysis of 323 medical histories of patients with acute urological pathology who needed emergency medical aid and were admitted to medical settings in the city of Poltava in 2020-2021. Patients were divided into 2 groups: without and with co-infection of COVID-19. Having analyzed the structure of urgent urological diseases and their course in patients with co-morbid COVID-19, we were able to highlight certain statistically reliable points: an increase in the number of inflammatory diseases of the kidney and urinary tract, an increase in the number of cases of macrohematuria, and an increase in the number of emergency interventions for purulent-septic kidney pathology. The pathogenetic mechanisms of the development of these conditions are currently not yet sufficiently studied and require separate studies to further improve the provision of urological care to patients in the context of the persistence of the COVID-19 pandemic.