[Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis]. / Analiz blizhaishikh i otdalennykh rezul'tatov traditsionnykh duodenumsokhranyayushchikh rezektsii golovki podzheludochnoi zhelezy i original'noi rezektsionno-dreniruyushchei metodiki pri khronicheskom pankreatite.

AIM: Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS: There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS: The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS: The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.

[Hepatolithiasis].

The authors present an analysis of treatment results in 14 patients with hepatolithiasis. An influence of chronic opisthorchosis invasion on the frequency was determined. Hepatolithiasis was detected in 8 (0.14%) out of 5757 patients, who underwent the operation for cholelithiasis and its complications. The disease was found out in 6 (0.31%) patients out of 1965, who had cholelithiasis and accompanying chronic opisthorchosis. It was 2,2 times more frequent due to proliferative sclerotic changes of biliary system. The trasdermal teanshepatic cholangiography was contraindicated for opisthorchiasis injuries, because of the danger of subcapsular cholangioectates damage. The endoscopic retrograde cholangiopancreatography and the endopapillosphincterotomy were complicated due to extensive structures of the large duodenal papilla and distal section of the general bile duct. The patients were treated by using the cholecystectomy, extraction of stones from ducts, reconstruction of liver passage. Choledochoduodenostomy was performed with compulsory external drainage for ducts sanation from infections and helminthes in the case of the opisthorchiasis. Interportal infusions were carried out. The surgical, conservative and endoscopic treatment was required for multiple colangiolithiasis. The lethality consisted of 7.1%.

[Internal biliary fistulas as a complication of cholelithiasis].

The authors made an analysis of observations of 46 patients. They describe algorithm and problems of clinico-instrumental and X-ray diagnostics, strategy of operative treatment and postoperative complications.

[Relaparotomy and laparostomy in treatment of early postoperative complications].

The cause-and-effect analysis of early (within 3 weeks after the initial surgery) relaparotomy was made, using the experience of 5286 laparotomized patients, of whom 82 (1,55%) had relaparotomy. The main reason of intraabdominal complications was the initial generalized peritonitis in emergency patients (85,4%). In comparison with data of 30 years prescription, the portion of postoperative peritonitis and bleeding had increased, though the number of eventrations and postoperative ileus, on the contrary, decreased. The introduction of laparoscopy eliminated the necessity of diagnostic relaparotomies. The mortality rate after the repeated surgery had decreased from 38,0% to 30,5%.

[The repeated operations for focal liver lesions].

Repeated operations for focal liver lesions were analyzed. 75 patients with parasitic liver lesions (alveococcosis, echinococcosis), 14 patients with liver tumors, 15 patients with cysts and abscesses were included in the study. For the first time patients underwent palliative operations or diagnostic laparotomy. In some patients relapse was observed after radical surgery in postoperative period. Ultrasound study was the main diagnostic method for detecting localization and extent of the lesion. 91 patients underwent radical surgery, including hemihepatectomy carried out to 26 patients, segmental and bisegmental liver resections carried out to 35 patients. Transparenchymatous Tung ligation was used in liver resections. Resection line was covered by hemostatic sutures according to B.I. Alperovich technique. Intraparenchymatous processing of Glisson pedicle according to E.I. Galperin method was applied in extensive liver resections. Cryodestruction was used for prophylaxis of relapses in parasitic and tumor lesions. Liver failure (4) and bleedings (2) were the most life-threatening postoperative complications. 4 patients died due to liver failure (2) and bleedings (2). Among 97 patients good results were observed in 73 (75,3%) patients, satisfactory - in 22 (22,7%), poor - in 2 (2,1%) with relapse of hepatocellular carcinoma.

[Ten years experience with using directed laparostomy in treatment of diffuse purulent peritonitis].

During the recent ten years operations were made on 331 patients with diffuse purulent peritonitis, 214 of them had traditional management of the postoperative period, 117 were managed using directed laparostomy by the method developed in the clinic. Toxic phase of peritonitis was noted in 66.76%, with the terminal phase--33.24% of patients, in the group of patients with laparostomy their number being 10% more than in the group of comparison (with a traditional method of management at the postoperative period). In cases with using directed laparostomy with programmed sanitation of the abdominal cavity the number of postoperative complications was 29.9%, 21.36% of patients died. In the group of patients with traditional management of the postoperative period there were 68.2% of complications, 80 patients (37.4) required relapatotomy, 55.6% died.

[Diagnosis and treatment of postoperative pancreatitis]. / Diagnostika i lechenie posleoperatsionnogo pankreatita.

Among 24,498 laparotomies performed for diseases and traumas of the abdominal organs 72 were complicated by postoperative pancreatitis. The most frequently encountered symptoms of postoperative pancreatitis were pain in the upper abdomen, marked intestinal paresis, tachycardia, hyperthermia, and vomiting. Treatment was started with conservative measures, including controlled hemodilution and forced diuresis. If these measures failed, operation was undertaken. Operations were carried out on 21 patients: pancreatic blockade (n = 8), abdomenization (n = 8), cryodestruction (n = 5). The omental bursa was drained through a lumbar approach. Intra-aortic infusions and immunostimulation therapy were conducted in the postoperative period. Nine patients died (2 of them were not operated on). Death was caused by pancreonecrosis.

[The diagnosis and treatment of mechanical jaundice of parasitic origin]. / Diagnostika i lechenie mekhanicheskikh zheltukh parazitarnogo proiskhozhdeniia.

From analysis of 230 cases of obstructive jaundice consequent upon opisthorchiasis, alveococcosis, and echinococcosis its causes and the peculiarities of the clinical course were revealed: gradual development, a long duration, disturbed hepatocyte function in the early period, high incidence of cholangitis, deep disorders of immunological reactivity, and allergic reorganization of the organism. With due regard for these characteristics, recommendations are given in respect of the diagnosis, operative treatment, prevention of postoperative complications, and postoperative management.

[Surgical treatment of cysts and fistulas of the pancreas]. / Khirurgicheskoe lechenie kist i svishchei podzheludochnoi zhelezy.

Forty-six patients were treated for cysts and fistulas of the pancreas most of which were caused by destructive pancreatitis and trauma of the pancreas. Operations were performed for pancreatic cysts on 22 patients: marsupialization of the cyst (7 patients), cystoenteroanastomosis (11), resection of the gland together with the cyst (3 patients, one of them died), and cytogastroanastomosis (1). Operations for pancreatic fistulas were carried out in 16 patients. Fistuloenterostomy on a "lost" drain with a jejunal loop excluded after Roux is considered to be the operation of choice in the clinic. The fistula recurred in one patient but was reoperated on successfully.

[Treatment and prevention of neoplastic large intestine obstruction]. / Lechenie i profilaktika opukholevoi tolstokishechnoi neprokhodimosti.

An analysis of results of treatment of 101 patients has shown that under favorable conditions (the absence of peritonitis, satisfactory state of the patients) it is possible to use resection of the intestine with primary anastomosis and disloading stoma. The endoscopic examination should be used for prophylactics of tumorous colonic obstruction.