[Total laparoscopic retrieval of a cava filter: case series]. / Polnost'iu laparoskopicheskoe udalenie kava-fil'tra: seriia sluchaev.

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.

[Methods of acute pancreatitis prevention after endoscopic transpapillary interventions].

AIM: To optimize preventive methods of acute postoperative pancreatitis in endoscopic transpapillary interventions. MATERIAL AND METHODS: It is performed parallel unblinded randomized investigation. The first group included 98 patients who underwent endoscopic transpapillary interventions and thoracic epidural analgesia (TEA). The second group consisted of 97 patients in whom opiate analgesic intramuscularly and indomethacin per rectum were applied. RESULTS: Study revealed that acute pancreatitis has been diagnosed significantly more seldom in patients after TEA than in the second group (OR 0.22, CI 95%, 0.06-0.83). Thus in TEA-group pancreatitis was verified in 3.1% (3 of 98 patients), in the second group - in 12.4% (12 of 97 patients). Incidence of pancreatitis decreased from 23.3% (10 of 43) to 4.3% (2 of 46) among high risk patients (OR 0.15, 95% CI 0.03-0.75). CONCLUSION: TEA is effective and justified preventive method in patients with high risk of postoperative pancreatitis. In low risk patients use of indomethacin per rectum is preferred compared with TEA due to its invasiveness.

[Evolution of approaches to surgical treatment of complicated cholecystitis]. / Evoliutsiia podkhodov k khirurgicheskomu lecheniiu oslozhnennogo kholetsistita.

More than 17 thousand surgeries for calculous cholecystitis and its complications including 560 repeated surgeries on the major bile ducts were performed. Based on this experience three stages in treatment of complicated cholecystitis are distinguished. Principal changes of surgical policy are the criteria of this division. From 1993 a tendency towards mini-invasive surgery in complicated cholecystitis was developing. Optimal terms of surgery, adequate scope improved technique improve significantly results of surgical treatment of complicated cholelithiasis.

[Papillovirsungocystoduodenoplasty in the treatment of cysts of the pancreatic head]. / Papillovirsungotsistoduodenoplastika v lechenii kist golovki podzheludochnoi zhelezy.

Experience in the treatment of cystic lesions of the pancreatic head is analyzed. The method of internal drainage of the pancreatic head cyst with transduodenal approach is described. This methods includes three stages: papillosphincteroplasty, deep virsungotomy with virsungoplasty and cystovirsungoplasty through ducts. The method is named papillovirsungocystoduodenoplasty (PVCDP). Results of 6 successful PVCDP are presented. There were neither recurrence of the cyst nor lethal outcomes.

[Reparative and reconstructive surgery of the bile ducts]. / Vosstanovitel'nye i rekonstruktivnye operatsii na zhelchevyvodiashchikh protokakh.

Fifty-three restorative and 61 reconstructive operations were carried out in 108 patients, 12 of them for the first time and 102 for the second time. The most frequent reasons for the operation were cicatricial strictures of the duct after an iatrogenic injury. The highest reliability of the intervention is attained by exact establishment of the diagnosis, timely intervention, approximation of the walls of the organs which are sutured, and adequate drainage.

[Errors in ultrasonic diagnosis of abdominal diseases]. / Oshibki ul'trazvukovoi diagnostiki zabolevanii organov briushnoi polosti.

Errors in the ultrasonic diagnosis of diseases of the abdominal organs in 2,218 patients were analysed in comparison to endoscopic and operative findings. The errors were few in number. A precise diagnosis was established in 99.6% of cases with acute cholecystitis and in 78% of those with a pathological process in the biliary tract. A maximum number of errors (7 per 42 cases) was encountered in carcinoma of the gallbladder. Ultrasonic examination may serve as the basis for choosing the method of rational therapy in diseases of the liver, pancreas, and complications in the postoperative period. Thus, the results of ultrasonic examination may be fully relied on or may be used as a basis for choosing manipulations which are more invasive in character.

[Special methods of examination in the diagnosis of cholelithiasis]. / Spetsial'nye metody issledovaniia v diagnostike kholelitiaza.

Rational combination of special methods of examination yields exact, objective, and detailed information for the diagnosis of cholelithiasis. Ultrasonic examination (USE) is an absolutely noninvasive method and therefore precedes all the other methods. USE suffices for the diagnosis of uncomplicated calculous cholecystitis. USE and intravenous cholegraphy are indicated in complicated cholecystitis without jaundice, USE and percutaneous transhepatic cholegraphy--in the presence of jaundice. These methods of examination are supplemented with endoscopic retrograde cholangiopancreatography in cases which are difficult for differential diagnosis and in those with cicatricial strictures of the bile ducts. Laparoscopy and aspiration biopsy of the liver usually complete the examination. In emergencies diagnostic laparoscopy, despite its definite invasive character, is conducted after USE.