Treatment of GERD
For GERD, conservative treatment is often prescribed: constant use of drugs that reduce the acidity of gastric juice and a strict dietary regimen. However, once it is stopped, all manifestations of GERD return. In addition, long-term use of such medications increases the risk of stomach cancer and worsens the entire digestive process. Therefore, they often resort to surgery.
It becomes necessary if conservative therapy is ineffective, GERD is combined with a hiatal hernia (HH) or complications arise, especially Barrett's esophagus. In Russia, this is almost always a Nissen fundoplication, during which a closed cuff is formed from the fundus of the stomach around the esophagus.
It helps get rid of reflux, but disrupts the function of the lower esophageal sphincter. The possibility of such physiological protective mechanisms as belching and vomiting is lost, and swallowing becomes difficult. In addition, in two out of three cases after Nissen surgery, GERD recurs within one to two years.
The ruble suffered geopolitical damage
EU diplomacy chief Josep Borrell and US Secretary of State Antony Blinken rejected the “Russian initiative to restore spheres of influence in Europe” and advocated a “strong, clear and united transatlantic alliance,” the EU foreign policy office said in a statement.
“High Representative Borrell and Secretary of State Blinken rejected the Russian initiative to restore spheres of influence in Europe and emphasized their determination to continue intensive consultations on this and other issues between the US and the EU, presenting a strong, clear and united transatlantic alliance,” the TASS statement quotes.
The document emphasizes that “close coordination between the European Union and the United States on recent developments related to Russia and Ukraine continues at the highest level.” “High Representative Borrell and Secretary of State Blinken reaffirmed support for the sovereignty, independence and territorial integrity of Ukraine and emphasized the need for Russia to de-escalate the situation and fully implement the Minsk agreements. They reviewed ongoing preparations for deterrence measures and a strong international response with serious consequences for Russia in the event of any further aggression against Ukraine,” the statement said.
At the same time, Borrell and Blinken stated that “the EU and the United States remain open to dialogue with Russia, but never at the expense of the freedom, sovereignty, and independence of members of the transatlantic community and their partners.”
Russia has repeatedly rejected false US assessments that it is preparing to invade Ukraine. Moscow stated that the United States had developed a special operation plan to worsen the situation around Ukraine and blame Russia for this. The Kremlin explained that information tension around the movements of Russian troops on its territory is being intensified to demonize Russia and position it as an “aggressor.”
On Saturday, US Under Secretary of State for Political Affairs Victoria Nuland said talks on security guarantees between the United States and Russia had allowed each other's concerns to be heard, but serious discussion had not yet begun.
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On Friday, Foreign Minister Sergei Lavrov said that if Russia's proposals for security guarantees are rejected, then, as Russian President Vladimir Putin said, Russia "will make a decision taking into account all factors, primarily in the interests of reliable security." He also said that Russia expects written responses from the United States and NATO on security guarantees. On the same day, Russian President Vladimir Putin was informed about the results of negotiations with the United States and NATO.
On Tuesday, US Permanent Representative Julianne Smith said that not a single NATO country is ready to compromise with Russia on the topic of expanding the alliance; the organization is not considering the possibility of “rolling back to the borders of 1997.” On the same day, US Deputy Secretary of State Victoria Nuland invited Finland and Sweden to discuss joining NATO.
Last Friday, US Secretary of State Antony Blinken made a statement that the West allegedly did not guarantee Moscow that NATO would not expand eastward. On the same day, NATO Secretary General Jens Stoltenberg said that the alliance would not compromise with Russia on key security issues, including the right of countries to join.
Last December, President Vladimir Putin said that the North Atlantic Alliance had “cheated” Russia when it promised to prevent expansion to the East in the 1990s. On December 1, President Putin proposed starting negotiations on providing Moscow with reliable and long-term security guarantees, developing specific agreements excluding any further NATO advances to the East and the deployment of weapons systems that threaten Russia in close proximity to the borders of the Russian Federation.
In December 2022, the Russian Foreign Ministry distributed two Russian draft documents to ensure legal security guarantees from the United States and NATO member countries. The draft agreement with the United States and the agreement with the alliance were handed over to the American side on December 15 at a meeting at the Russian Foreign Ministry.
In the draft agreement with NATO, Russia proposed that the alliance undertake a commitment to further non-expansion, including excluding the accession of Ukraine. Moscow called on the alliance to abandon any military activity outside its borders - in Ukraine and other territories of Eastern Europe, the Transcaucasus and Central Asia. The Alliance was asked not to deploy additional weapons or new military contingents outside the countries in which they were located as of May 1997 (before the inclusion of Eastern European countries in NATO).
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Surgical treatment of GERD in Moscow
At the Swiss University Clinic in Moscow, a laparoscopic improved version of partial Toupet fundoplication is performed for GERD. Unlike the Nissen technique, the cuff surrounding the lower part of the esophagus is made unclosed; it is created only 3⁄4 of its circumference, enveloping the esophagus only from the back and from the sides for 270o. Thus, it prevents the reflux of the contents of the underlying sections of the digestive tract into the esophagus, but does not interfere with the implementation of physiological mechanisms.
Patients operated on by Toupet radically get rid of reflux and then do not need medications or dietary restrictions. At the same time, they swallow freely, their belching and vomiting mechanisms are not impaired, so there is no heaviness, bloating or other discomfort associated with nutrition.
The head and chief surgeon of the Swiss University Clinic is Professor Konstantin Viktorovich Puchkov. He is a well-known specialist in the field of classical and laparoscopic surgery far beyond the borders of Russia, one of the best surgeons in Europe. Having experience of 25,000 operations for various diseases, Professor K.V. Puchkov prefers to perform laparoscopic operations for GERD and hiatal hernia, which allow achieving excellent results in the safest and least traumatic way for the patient. He performed more than 2,000 such interventions, improving the Toupet technique and receiving a patent for a new modification.
Puchkov Konstantin Viktorovich
Good day to everyone who is currently on the site! My name is Natalya Tarygina, I am 34 years old, I was born in February 2012. I had an operation with Konstantin Viktorovich, and was very pleased with his work, this man, as people say, is a doctor from God, I don’t know what would have happened to me if I hadn’t gone to him….
At the end of January, I found out that I had a huge fibroid on my uterus - 21 weeks, I found out when I was in the 15th Filatov hospital in Moscow. The doctors in this hospital treated me as if I was not a person - they spoke very rudely, did not pay any attention to me at all, to my question - what should I do now, the head of the gynecology department, without any regret and without any understanding in their eyes answered without thinking - just cut it out along with the uterus, but why do you need it? Without even asking whether I have children or not!!!!!!!!………
But I don’t have children yet, but I want them so bad!!!!! I also asked the doctors at Hospital No. 15: is there absolutely nothing that can be done to save the uterus? To which I heard the answer - well, I don’t know who will take on this, it’s your own fault that you started the disease like this, we’ll discharge you tomorrow, go to your clinic, and let them refer you for a planned operation…….
You simply cannot imagine what happened to me... , I didn’t want to live with such a diagnosis, I cried all day and night, but then I pulled myself together and gathered my thoughts about what I should do. I don’t know any gynecologists, I went to Elena Malysheva’s website, where she talked about my sore in the program “Live Healthy”, there, live, I saw Konstantin Viktorovich Puchkov performing an operation on a girl right in the studio to remove fibroids, also of large size with the preservation of the organ, and suddenly I had at least some hope. I was discharged from the 15th hospital and straight to the clinic with Konstantin Viktorovich the very next day, there, already at the reception, I was met by very friendly girls, I especially remember Olya - a kind-hearted person, you look at her smile, and the desire to live already appears in you ….
And so every doctor in this clinic will be very attentive to you, friendly, will always listen to you with understanding, and will give practical advice. In general, I passed all the tests, I received the results immediately after 10 minutes. based on the results, Konstantin Viktorovich said that it would be possible to remove the fibroid and save the uterus - my happiness knew no bounds, I began to prepare for the operation, two weeks later I was operated on, although my operation was abdominal - the fibroid was very large, but this is not the main thing , as you understand, the main thing is that they saved my uterus, and I will be able to have children in the future. The operation was successful, they cut out my 2.5 kilogram myoma... Three days later I was discharged, and during these three days I realized that there are still very good doctors and nurses. Many thanks to YOU Konstantin Viktorovich for the work done, I thank YOU from the bottom of my heart for giving me the opportunity to be a woman, and in the future to feel like a mother, I am very grateful to YOU, and I am also grateful to the gynecologist Yulia Evgenievna Andreeva, who, even due to her workload, will never refuse advice to you if you have any questions, she will always politely answer you by phone, even at 24-00, even at 03-00 in the morning, if you have health problems. I'm just shocked by the attitude in this clinic...
Nowadays, wherever you turn, everyone just growls at you - in state hospitals or clinics, but here, I couldn’t believe my eyes... This doesn’t happen in all even paid hospitals, here the doctors do their work with all their hearts, I didn’t notice any greed about money here at all, they want to help you, and they don’t mind giving you money for it, and that’s not the price for preserving such an important organ for starting a new life!!!!!!!!! I am very pleased that I came here and I don’t regret it one bit.
So, dear girls, women - if you suddenly have such a problem, don’t waste your time looking for a cheaper doctor, don’t waste your time, but go boldly to Konstantin Viktorovich Puchkov, you won’t regret it!!!! !!
THANK YOU SO MUCH KONSTANTIN VIKTOROVICH, once again for YOUR WORK!!!!
Natalia [email protected]
