Aliyev Saigid Alievich Professor. Method of pylorus-sparing gastrectomy

The invention relates to surgery and may be applicable for pylorus-preserving gastrectomy. The right gastric artery is ligated parietally 1 cm above the pyloric sphincter. The stomach is removed, and it is crossed at a distance of 20 mm from the pylorus. The ends of the esophagus and the pre-pyloric segment are anastomosed to form a single-row precision suture with restoration of the pyloric closing function. The method allows you to prevent tension on the sutured organs, create a physiological anastomosis, and reduce the risk of developing reflux and dumping syndrome. 3 ill.

Drawings for RF patent 2417771

The invention relates to medicine, namely to surgery, and can be used for the reconstructive stage of gastrectomy.

High-tech, organ-preserving operations in functional surgical gastroenterology for precancerous and oncological diseases are becoming increasingly widespread in world practice and are considered promising.

The surgical method of treating a number of organic diseases of the stomach is the main method today, and gastrectomy occupies one of the main places in the arsenal of surgeons. A frequent and serious complication of gastrectomy in the early postoperative period is the failure of the esophageal-small intestinal anastomosis (1.5-25%), the mortality rate of which reaches 25-100% (Chernousov A.F. et al., 2004; Davydov M.I. et al., 1998; Doglietto G.B. at all., 2004; Isguder A.S., 2005). The development of incompetence of the esophageal-small intestinal anastomosis is influenced by a large number of factors, but the leading role is played by the method of formation of the anastomosis. In addition, long-term results of reconstructive interventions during gastrectomy are determined by the presence of post-gastrectomy syndromes (dumping syndrome, afferent loop syndrome, reflux esophagitis, etc.). The development of many postoperative pathological syndromes is associated with the elimination of duodenal transit.

Several methods have been proposed to preserve duodenal transit during gastrectomy by directly connecting the esophagus to the duodenum and interposition with a small intestinal graft. These methods require mobilization of the duodenum and the head of the pancreas, mobilization of the esophagus in the mediastinum, an increase in the number of anastomoses during gastroplasty, inevitable tension of the tissues of the sutured organs, and in some cases the inability to compare the ends of the esophagus and duodenum. In addition, with all the proposed methods, there is no sphincter (closing) mechanism during esophagoduodenostomy, which leads to severe postoperative suffering in patients with the development of postgastrectomy syndromes.

An analogue of this model is proposed by P.M. Gaziev terminolateral esophagoanastomosis (patent No. 2266064 dated 02/02/2004).

The duodenum is mobilized along with the head and part of the body of the pancreas. The duodenal stump is sutured with double-row interrupted sutures. A terminolateral esophagoduodenoanastomosis is applied to form a reservoir from the duodenal stump above the anastomosis at an angle of 30 degrees to the anastomosis, for which the posterior wall of the abdominal portion of the esophagus is fixed to the duodenal stump, placing three sutures on the sides in the oral direction. An anastomosis is performed between the esophagus and the anterolateral wall of the duodenal bulb, opening it transversely 4 cm from the end of the stump. An anastomosis with a diameter of 2-2.5 cm is formed. The duodenal stump is fixed to the diaphragmatic pedicle.

Flaws:

1) Mobilization of the duodenum with the pancreas leads to the destruction of the pacemaker zone, which affects its motor-evacuation function.

2) Deterioration of blood supply to the duodenum during the mobilization stage (high risk of anastomotic failure).

3) When a reservoir is formed from the duodenal stump above the anastomosis, a “blind” sac is formed. Food masses can accumulate in it, which leads to overdistension, ulceration and perforation of the intestinal wall.

4) In the early postoperative period, the development of incompetence of the duodenal stump is possible.

The prototype of the proposed method is the method of direct esophageal-duodenal anastomosis according to A.M. Karyakin (Ivanov M.A. Comparative assessment of variants of esophageal-intestinal anastomoses and the possibility of correcting functional intestinal disorders during gastrectomy: Dissertation of Doctor of Medical Sciences. St. Petersburg, 1996; 368), which consists of manual mobilization of the lower thoracic and abdominal sections of the esophagus with subsequent comparison of the anastomosed segments of the hollow organs.

This method also has its disadvantages:

1) The rhythm of the digestive tract is disrupted in the absence of the closure apparatus.

2) The imposition of an end-to-end anastomosis without preserving the pyloric sphincter leads to duodenoesophageal reflux disease with the development of Barrett's esophagus, dumping syndrome.

3) Systematic performance of direct esophagoduodenoanastomosis encounters significant difficulties associated with the tension of the sutures in the anastomosis area.

Thus, the prevention of early and late postgastrectomy complications is an urgent problem.

The purpose of the invention is to develop a method for pylorus-sparing gastrectomy, eliminating the need to mobilize the lower thoracic esophagus and the lower horizontal segment of the duodenum with the absence of tension on the sutured organs, allowing to prevent the development of early and late post-gastrectomy complications with the expansion of indications for more physiological surgery.

The goal is achieved by the fact that the border of gastric mobilization passes 20 mm proximal to the pylorus with preservation of the marginal vessel, innervation, systemic normotension in the vessels of the suture strip of the prepyloric segment, followed by the formation of a single-row suprapyloresophageal anastomosis. The method of pylorus-preserving gastrectomy is the most physiological, it allows you to maintain the rhythm of the digestive tract, i.e. portioned intake of food into the duodenum prevents the development of early surgical postoperative complications and diseases of the operated stomach in the long term: esophagoduodenal reflux disease, Barrett's esophagus, dumping syndrome.

The essence of the invention

The essence of the proposed method is illustrated in the drawing, where position 1 - esophagus, position 2 - pyloric sphincter, position 3 - duodenum, position 4 - anastomosis, position 5 - right gastric artery. Presented (Appendix 1) are photographs of successive stages of operations on experimental animals. Presented (Appendix 2) are X-ray images of a control study of patient V., 40 years old, who underwent an operation - pylorus-preserving gastrectomy, where the preservation of the function of the pyloric sphincter, portioned entry of barium suspension into the duodenum, and free patency of the anastomosis are clearly noted.

The proposed method of pylorus-sparing gastrectomy is as follows.

The operation itself consists of resection and plastic stages. Diagnosis of duodenostasis with a statement of periodic bowel activity and consistently high intraluminal pressure of at least 30 mm water column, associated with the retrograde spread of frontal activity, allows one to avoid operational and tactical errors when establishing indications for surgery involving the inclusion of the duodenum in digestion.

One of the indispensable conditions that ensure the full functional state of the muscular-vascular sphincter - the pyloric sphincter - is the preservation of blood supply and innervation. Adequate preservation is achieved by parietal ligation of a branch of the right gastric artery located 2 cm proximal to the pyloric sphincter. At the same time, against the background of extraorgan vagal denervation, intramural nervous regulation is preserved.

The resection stage is performed in compliance with the basics of oncological radicalism in the scope of lymph node dissection D2 for cardiogastric cancer with the distal border of the lesion not lower than the angle of the stomach and for benign diseases: diffuse gastric polyposis, post-burn extended strictures.

The stomach is transected proximally from the esophagus, the distal line of intersection runs along the line of mobilization, 20 mm away from the pylorus.

After removal of the stomach, the end of the esophagus and the prepyloric segment are compared, and an end-to-end anastomosis is performed with precision atraumatic 3/0-4/0 suture material between the segments of the digestive tract. At the same time, the valve mechanism of the pyloric sphincter is preserved.

An essential feature of the proposed method of operation is the implementation of parietal mobilization with preservation of the pyloric sphincter; the right gastric artery is ligated 1 cm above with cutting out the pre-pyloric segment - a strip 20 mm wide.

Thus, ensuring vascularization and innervation of one of the most important reflexogenic zones - the “pyloric sphincter - duodenal bulb” is one of the essential points in our work.

Comparative analysis of the features of the prototype and the proposed invention

Prototype features

Transhiatal, abdomino-posteriormediastinal access for mobilization of the esophagus;

Kocher mobilization of the duodenum is widely used;

The plastic stage of the operation is performed without preserving the pyloric sphincter and forming a direct esophagoduodenal anastomosis.

Features of the invention

Lack of wide mobilization of the esophagus with transhiatal expansion of access;

Ensuring vascularization and innervation of the most important reflexogenic zone - “pyloric sphincter - duodenal bulb”;

Carrying out parietal mobilization with preservation of the pyloric sphincter, the right gastric artery is ligated 1 cm above with cutting out the pre-pyloric segment - a strip 20 mm wide;

The right gastric artery is ligated parietally 1 cm above the pyloric sphincter, and for the plastic stage of the operation a pre-pyloric segment of a suture strip 20 mm wide is cut out, preserving the vascular connections of the muscular-vascular sphincter - pyloric sphincter against the background of preserved intramural nervous regulation with the formation of a single-row precision suture of the anastomosed segments digestive tract with restoration of the pyloric closing function.

Example of concrete implementation

Extract from the laboratory journal of the Department of Operative Surgery of the DSMA

The study was conducted on 12 outbred dogs, which were divided into two groups: experimental (n=6) and control (n=6). The dogs of the experimental group, under intrapleural anesthesia, underwent an upper median laparotomy, parietal mobilization of the stomach with preservation of the pyloric sphincter, while the right gastric artery was ligated 1 cm above with cutting out the prepyloric segment of the i-stripe 20 mm wide. The stomach is transected proximally from the esophagus, the distal line of intersection runs along the line of mobilization, 20 mm away from the pylorus. After removal of the drug, the end of the esophagus and prepyloric segment was compared with the imposition of an end-to-end anastomosis with precision atraumatic 3/0-4/0 suture material between the segments of the digestive tract. Animals in the control group underwent gastrectomy according to the standard method (without preserving the pyloric sphincter), mobilization of the esophagus transhiatally, mobilization of the duodenum according to Kocher with the application of esophagogoduodenostomy according to A.M. Karyakin (prototype). The results of surgical intervention were assessed on the 5th, 7th, 14th and 30th days. Morphological changes in the esophagus, duodenum, and anastomosis were assessed visually, recorded and photographed. Resection of the anastomosis was performed, followed by histological examination of preparations stained with hemotoxylin and eosin, according to Romanovsky-Giemsa, according to van Gieson, and with silver nitrate according to Foote.

In the Faculty Surgery Clinic No. 2 of the DSMA, the method of pylorus-preserving gastrectomy was used in 4 patients, and the control group consisted of 11 patients who underwent direct esophagoduodenoanastomosis according to A.M. Karyakin. The results of gastrectomy options were assessed clinically, radiologically and endoscopically with a biopsy of the anastomosed segment and subsequent histological examination of the preparations.

Patient V., 56 years old, medical history No. 456, was hospitalized at the Faculty Surgery Clinic No. 2 of the DSMA on April 13, 2009 with a clinical diagnosis: poorly differentiated adenocarcinoma of the gastric cardia, stage III (T 3 N 1 M 0). After preoperative preparation, on April 21, 2009, an operation was performed - pylorus-preserving gastrectomy.

A comparative analysis of the results of experiments and clinical observations showed:

Experimental series. In the experimental group of animals, the postoperative period proceeded without complications, no deaths were noted; on the contrary, two dogs in the control group died on the 4th and 7th days after surgery. On section, in both cases, diffuse peritonitis was discovered due to incompetence of the esophageal-duodenal anastomosis. A defect in the anastomosis was observed along the anterior wall. Further observation of laboratory animals showed an earlier restoration of motor activity and feeding in the group of animals that underwent pylorus-preserving gastrectomy.

Clinical observations. In the clinical study, no deaths were noted in both the study and control groups of patients, however, clinical, radiological and endoscopic assessment of the results of surgical intervention showed a significant advantage of pylorus-sparing gastrectomy, expressed in improved general well-being (absence of bitterness, heartburn), early recovery intestinal motor function, motor activity of patients and enteral nutrition.

The postoperative period of patient V., 56 years old, proceeded smoothly, without complications. On the 6th day, the nasogastric tube was removed, and on the 7th day, enteral nutrition was established. During a control X-ray examination, the anastomosis is freely passable, the pyloric sphincter functions satisfactorily, the evacuation of barium suspension into the duodenum is free and timely. The patient was discharged on the 10th day after surgery in satisfactory condition.

Utility of the invention

The method of pylorus-sparing gastrectomy was tested four times in the faculty surgery clinic No. 4 of the Dagestan State Medical Academy.

In oncosurgical gastroenterology, organ-preserving operations have become increasingly widespread. The functional advantages of preserving the duodenal passage and pyloric sphincter have been proven. Therefore, the search and improvement of technology and more functionally beneficial operations continues.

Gastrectomy with preservation of the pyloric sphincter is the most “physiological” operation among other methods of gastrectomy, since it allows you to preserve the natural passage through the duodenum, ensure portioned evacuation, and prevent duodenal-esophageal reflux and dumping syndrome. Expanding the indications for esophagogoduodenostomy with preservation of the pylorus after gastrectomy allows one to obtain good functional results of gastrectomy.

The method causes less trauma, is shorter in duration, and is therefore accompanied by a low percentage of postoperative complications.

The method of pylorus-sparing gastrectomy is the most physiological, it allows you to maintain a portioned supply of food into the duodenum, prevents anastomotic failure by maintaining adequate blood supply, the absence of tension on the anastomosed ends, and prevents the development of post-gastrectomy complications

Expanding the indications for organ-saving operations with preservation of the pylorus and inclusion of duodenal digestion is the key to the prevention of post-gastrectomy complications; at the same time, the development of post-gastrectomy syndromes is prevented: reflux esophagitis, Barrett's esophagus, dumping syndrome.

The proposed method of gastrectomy can be used in abdominal surgery as a reconstructive step after removal of the stomach.

Sources of information

1. Chernousov F.A., R.V.Guchakov. Reconstruction techniques and methods for forming anastomoses after gastrectomy for stomach cancer. // Surgery. Journal named after N.I. Pirogova, 2008; 1: p.58-61.

2. R.M. Gaziev Terminolateral esophageal anastomosis - patent No. 2266064 dated 02.02.2004

3. Ivanov M.A. Comparative assessment of options for esophageal-intestinal anastomoses and the possibility of correcting functional intestinal disorders during gastrectomy: Dis. Dr. med. Sci. St. Petersburg, 1996; 368 - prototype.

FORMULA OF THE INVENTION

A method of pylorus-preserving gastrectomy, which consists in removing the stomach, characterized in that the right gastric artery is ligated parietally 1 cm above the pyloric sphincter, the stomach is crossed at a distance of 20 mm from the pylorus, with preservation of the vascular connections of the sphincter - pyloric sphincter against the background of preserved intramural nervous regulation, anastomose the ends of the esophagus and the pre-pyloric segment with the formation of a single-row precision suture with restoration of the pyloric closing function.

Aliev Saigid Alievich is a leading doctor in the field of oncological pathology in the Republic of Dagestan. He has the honorary title of Professor in the field of oncological and surgical pathologies. Doctor of Medical Sciences, doctor of the highest qualification category. Head of the Department of Oncology, Dagestan State Medical Academy. He is the chairman of the regional society of oncologists and chemotherapy specialists. Chief oncologist at the Ministry of Health of the Republic of Dagestan. Head of a republican clinic specializing in the treatment of cancer patients.

Brief biography of Professor Saigida Alievichna Aliyeva

Aliev Saigid Alievich is one of the most honorable residents of the Republic of Dagestan. He made a huge contribution to the development of medical care for cancer patients. Thanks to him, one of the best departments with the latest equipment and the best oncologists appeared in Dagestan. The department employs the city's leading oncologists. A huge number of patients are served on the basis of this medical institution. The professor is known not only for his ability to operate and good positive dynamics in the treatment of cancer processes. But he also has a huge number of scientific achievements to his credit. He organized a school for leading doctors and future oncologists on the basis of the Dagestan Medical Academy. His personal awards and achievements include many printed resources published under his strict leadership.

Scientific achievements of the doctor.

Aliev Saigid Alievich – oncologist

Aliev Saigid Alievich - inventor. So, he is the holder of a number of patents. Under his leadership, scientific papers for various degrees are written and successfully defended. On his professional account, doctor Aliev S.A. has several thousand successful surgical interventions. The doctor is a big supporter of organ-preserving interventions, so he tries to preserve the organ and its function as much as possible. Many of the patients quickly return to a normal lifestyle, forgetting about the experience. Aliev Saigid Alievich is a very good teacher. He regularly lectures and teaches students his subject. For many students, the Professor is an example and an incentive. The doctor repeatedly speaks at symposiums and congresses of oncologists in Russia. With great pleasure he completes courses that help improve his professional level. Has the highest qualifications.

Dear readers, today we visited a new hospital in Makhachkala - ANO "City Clinical Hospital No. 3", in particular, the surgical department. The surgical department is headed by a candidate of medical sciences, a surgeon of the highest qualification category, a member of numerous Russian and international surgical and oncological scientific communities, Saparchamagomed Magomedov. Taking this opportunity, we asked him a few questions.

- Saparchamagomed Magomedovich, tell us about the structure of the surgical department.

The surgical department of City Clinical Hospital No. 3 is located on the fourth floor of the main medical building of the clinic and has 20 beds. The structure of the surgical department includes an intensive care unit with seven beds, where postoperative patients are under the supervision of resuscitators with round-the-clock monitoring of vital functions.

The operating unit includes two operating rooms with a modern ventilation and air purification system supplied by laminar flows.

- What diseases do patients most often treat and what operations are performed in the department?

Patients are hospitalized in the surgical department with pathologies of the liver (cysts), gallbladder (cholelithiasis, polyps), pancreas (pancreatitis, cysts), kidneys (cysts), spleen (cysts), stomach (complicated ulcers, polyps, tumors), 12 -duodenal (ulcerative-scar stenoses), colon (diverticula, tumors), with pathology of the anterior abdominal wall (hernias: inguinal, femoral, umbilical, linea alba, postoperative ventral; diastasis of the rectus abdominis muscles), with benign skin diseases, subcutaneous tissue (lipomas, fibromas, etc.).

The department performs a wide range of different surgical interventions, mainly using minimally invasive modern technologies. The clinic’s surgeons have at their disposal a modern laparoscopic system in high-resolution Full HD format, which allows them to perform surgical interventions with more precision (like a jeweler).

We have introduced navigation surgery in the department, which allows surgical interventions to be performed without incisions under the control of a modern ultrasound system. All modern technologies used are aimed at reducing the trauma of operations and allow the patient to return to their usual way of life as quickly as possible.

- The operations performed in the clinic are probably expensive, do patients have to bear financial expenses?

The opening of this hospital was initiated by the Muftiate of the Republic of Dagestan with the aim of helping people who find themselves in difficult life situations due to illness. All expenses for treating patients both in the surgery department and in the therapeutic department are borne by the hospital operating under the compulsory medical insurance system.

Patients do not incur any financial expenses, however, receiving modern technological surgical care using foreign (Ethicon, Cavidien, Bard) consumables (endoprosthetic meshes, suture material, catheters, drainage systems, etc.).

- The surgical department was opened in January. How many operations were performed in the department during this period?

To date, the Department of Surgery has performed more than 170 operations of varying complexity. All operated patients were discharged with recovery (Al-Hamdu li-Llah). They all left satisfied with both the doctors and the paramedical and junior medical staff.

- Tell us a little about yourself and your professional growth.

In 2001, I graduated from Makhachkala secondary school No. 30 with a gold medal and entered the Dagestan State Medical Academy, from which I graduated with honors in 2007.

Next, two-year training in clinical residency in surgery under the guidance of Professor Saygid Alievich Aliev at two clinical bases (surgical and oncological departments). After completing his clinical residency, he was employed in the thoracoabdominal oncosurgical department of the Dagestan Center for Thoracic Surgery, and at the same time studied in graduate school, which resulted in the defense of his Ph.D. dissertation in 2013.

For his contribution to the development of invention in medicine (patents), he was awarded the Alfred Nobel Gold Medal by the Presidium of the Academy of Sciences (Moscow). During his studies (residency, graduate school) and work, he completed numerous internships in Moscow, St. Petersburg, Kazan, Rostov, etc.

In May-June I have an internship planned in Munich, Germany. Surgery is constantly evolving, like all medicine in general, so we, doctors, need to improve ourselves and master new approaches and techniques that allow us to help patients as effectively as possible.

- Why did you decide to become a surgeon?

It is difficult to answer this question unambiguously. Since childhood, I have been drawn to complex decisions, and surgery is one of the complex areas of medicine. This is on the one hand, and on the other hand, my love for surgery was strengthened by the stories of my neighbor, a surgeon on the landing, who described all stages of operations, how he managed to get out of difficult non-standard situations and help people.

- Do you think doctors are born or made?

If we consider a doctor from the position of professionalism, then, of course, they become doctors, but it is not easy, it is everyday work aimed at self-education and self-improvement. However, a doctor also needs personal qualities (humanity, compassion, honesty and others) with which he must be born, and these qualities should be fundamental before choosing a medical activity.

- Is it difficult to gain the patient's trust?

You correctly noted the importance of the patient’s trust for the doctor. Gaining the patient’s trust is not an easy task, especially in surgery, but it can be done. Each patient is individual, and it is necessary to find a certain psychological approach to each.

We pay great attention to the initial contact with the patient, we try to listen to all his concerns, experiences, and doubts. The patient should see empathy and a desire to jointly solve the patient’s problem in the doctors’ eyes.

As a rule, patients come to us in a somewhat shocked state, since the very fact of the need for surgery frightens people very much, and this is normal, so we have to reassure patients, instill hope for a favorable outcome, we describe all stages of their stay in the clinic, and patients trust us .

- What place does religion occupy in your life?

My whole life is religion.

- What is most important to you – religion or profession?

This formulation of the question is not entirely correct, because I assess the importance of my profession from the point of view of religion. After all, every day by doing our work, helping people, we serve the LORD. We consider patients as slaves of the ALMIGHTY who have come for help and ask the CREATOR to make us the cause of delivering people from diseases and illnesses.

- How much of a role did religion play in your choice of profession?

At first I just liked surgery and was drawn to it. But later I came to understand the importance of the profession from the point of view of religion, responsibility for the lives and health of people before the CREATOR. Medicine is a rather interesting field of science for people who think: understanding even the elementary processes occurring in the human body in a split second is enough to realize the greatness of the CREATOR.

- Last question. Do you read our portal IslamDag.ru, and what would you wish for our readers?

To be honest, I rarely read, unfortunately, I don’t have much time, but when religious issues arise, your portal is a priority. I would like to wish my readers good health and iman, these are two inextricably linked components of a full-fledged person, the weakening of one of them reduces the other.

Interviewed Makhach Gitinovasov

There is no way to prepare for a cancer diagnosis. A person faced with this disease goes through a lot of questions in his head, the main ones being “what to do?” and “where to go?”

For problems in the thoracic and abdominal areas, there can be one answer - to the Dagestan Center for Thoracic Surgery. Over the three years of fruitful, highly qualified work of the clinic’s staff, assistance was provided to more than 2,500 patients. The center is headed by a doctor with a capital letter, Doctor of Medical Sciences, Professor, Head of the Department of Oncology and Ultrasound of the DSEA, Chief Oncologist of the Republic of Dagestan Saygid Aliyev.
On the appointed day for the interview, we came to Saygid Alievich, but before meeting with him we talked with the patients of the center, they all shared only positive reviews: “These are doctors from God, they have magic hands, when I came here, I didn’t even hope for recovery, but now I enjoy life again, thanks to them,” “I would like to especially note the very kind attitude of all the staff. The talented hands of the surgeon, the kindness and care of the entire team gave me a second life. I didn’t think that such doctors still existed - competent and decent, caring and attentive, with just their kind glance they are able to reassure and give hope. I am eternally grateful to them!”
After such words, we couldn’t wait to talk with Saygid Aliyev himself to learn more about the activities of the center. But Saigid Alievich turned out to be not one of those who talk a lot and like to brag, he immediately told us: “Let me show you our work visually.” And we went on a tour of the department of the Dagestan Center for Thoracic Surgery. “Just don’t be scared,” Saigid Alievich warned us, “mostly those patients who come to us are those who have been abandoned by other doctors and clinics, and here they receive the necessary medical care. First we will go to the intensive care unit - where patients are in the first days after surgery. We perform high-tech thoracoabdominal oncological surgeries on the thoracic, abdominal and neck organs. These are very complex operations, on average they last 6–7 hours. But the main thing is that the patients show signs of life already the next day after the operation. Although our center is not sufficiently equipped with modern equipment for diagnostics and minimally invasive surgical treatment of cancer patients. In terms of the breadth of surgical activity, complexity and results of the interventions performed (modified methods of Lewis, Garlock, Savinykh-Karyakin, M.I. Davydov, A.F. Chernousov to options for pancreatico-duodenal resection), the Dagestan Center for Thoracic Surgery is one of the best in the North Caucasus. But the subject of our special pride is the team. The Center's medical staff strives for excellence in patient care, which is manifested, first of all, in the high professionalism of the treatment provided, as well as in providing personal attention and the necessary support to the patient and his family members, both during hospitalization and during subsequent follow-up. The most important thing that we usually tell our patients is that a diagnosis of cancer is not a death sentence. People die from the flu too. No one faints when they hear that they have the flu, although a person also has a chance of dying from the flu. We hide the diagnosis from the patient when we understand that the prognosis is unfavorable. But, as a rule, we ask the patient to cooperate. When a patient understands what disease we are fighting, he responds much more adequately to medical prescriptions and tries to follow everything. Botkin is credited with the phrase: “There are three of us: you, me and your illness. And if you are with me, we will defeat her, if you are with her, I cannot cope alone.” This is a correct thesis, and it is especially important in relation to cancer patients.”
With bated breath, we listened to Saigid Alievich and watched the doctors work. I would like to note that the center is clean and tidy, patients are satisfied with the attitude and level of medical care. And the staff of the Dagestan Center for Thoracic Surgery take their work with great responsibility. For them, this is more than work, it is the meaning of life. “We are happy that every day we go into battle against the diseases of our patients. And there is no higher reward for us than victory in this battle,” Saigid Alievich finally told us. And these words speak volumes - the professionalism and integrity of the specialists of the Dagestan Center for Thoracic Surgery, their caring and sincere desire to help every patient!